RELATIONSHIPS OF CARDIOLOGICAL FINDINGS AND STANDARDIZED PSYCHOLOGICAL SELF-RATINGS TO CLINICAL SYMPTOMS IN 3705 PATIENTS REFERRED FOR EXERCISE TESTING

3705 out of 4826 consecutive patients who were referred for exercise testing, completed a questionnaire immediately before the test. The questionnaire asked for sociodemographic data, cardiac history and symptoms, and additionally contained a German version of the Hospital Anxiety and Depression (HAD) scale. 22.5% of the patients had HAD scores >10 indicating relevant anxiety or depression. High scores were associated with female sex, social problems, and normal cardiologic findings. After controlling for sex there was still a significantly higher portion of anxiety in men with angiographically normal vs. narrowed coronary arteries (20.6 % vs. 8.3 %; p =.0013). Cardiac symptoms as reported in the questionnaire showed slightly negative correlations (r =.00 to r = .15) with the number of narrowed coronary vessels, degree of left ventricular dysfunction and positive results of the exercise test. Multivariate analyses of variance revealed only minimal contributions of somatic findings to the explanation of symptom variance, while both HAD subscales accounted for the main portions of explained variance (p < .00005 for each symptom and overall symptom frequency). This could be explained by a selection process which lets numerous patients with heart-related symptoms of psychogenic origin seek a cardiologist's help, whereas many patients with coronary disease rather tend to deny their symptoms. Thus, even in a specialized cardiology service of a university hospital there are more patients with morbid levels of anxiety and depression than positive exercise tests. These patients are to be identified by means of an easily administered, objective, and well validated screening test. The HAD scale seems to meet these criteria and can be recommended for routine use.