Study on influencing factors of anxiety symptoms and its association with nutritional condition in elderly heart failure patients.

OBJECTIVE: To analyze influencing factors of anxiety symptoms in elderly heart failure patients and explore interrelationships between nutritional status, anxiety, and heart failure severity, to provide evidence for the formulation of integrated clinical intervention schemes combining psychological care and nutritional support. METHODS: This cross-sectional study included 204 elderly heart failure patients (age ≥65 years) hospitalized at The First Affiliated Hospital of Anhui University of Chinese Medicine's cardiovascular medicine department between May and December 2025. Patients' anxiety status was assessed using the Self-Rating Anxiety Scale (SAS) and categorized into an Anxiety group and a non-Anxiety group accordingly. Patients' socio-demographic data, clinical information, and laboratory indicators including N-terminal pro-brain natriuretic peptide (NT-proBNP), total protein (TP), and albumin (ALB) were collected; Nutritional condition, family support, and quality of life were concurrently assessed using the Mini Nutritional Assessment Short-Form (MNA-SF), Family Care Index Questionnaire (APGAR), and Minnesota Living with Heart Failure Questionnaire (MLHFQ). Binary logistic regression analysis was performed to identify independent influencing factors for anxiety; Spearman's rank correlation analysis was used to assess correlations between nutritional status and clinical indicators; and multiple linear regression analysis was conducted to identify independent influencing factors for nutritional status. RESULTS: Among 204 patients, 48.5% (n = 99) experienced anxiety. Significant differences were observed between the Anxiety group and the non-Anxiety group in NYHA cardiac function classification, number of comorbid chronic cardiovascular diseases, living alone status, NT-proBNP, HDL-C, LDL-C, TP, ALB, nutritional status, family care index, and quality of life (all p < 0.05). Binary logistic regression analysis revealed that NYHA cardiac function classification (OR = 7.826), NT-proBNP (OR = 12.177), and LDL-C (OR = 2.029) were independent risk factors for anxiety in elderly patients with heart failure (all p < 0.05), while HDL-C (OR = 0.264) and MNA-SF total score (OR = 0.434) were independent protective factors (all p < 0.05). Spearman's rank correlation analysis demonstrated that the MNA-SF total score was significantly negatively correlated with NYHA cardiac function classification (rs = -0.36), number of comorbid chronic cardiovascular diseases (rs = -0.324), NT-proBNP (rs = -0.334), LDL-C (rs = -0.163), MLHFQ total score (rs = -0.62), and SAS total score (rs = -0.832), while showing significant positive correlations with HDL-C (rs = 0.139), TP (rs = 0.276), ALB (rs = 0.258), and APGAR total score (rs = 0.402) (all p < 0.05). Multiple linear regression analysis revealed that higher APGAR total scores were associated with better nutritional status in patients; whereas elevated NT-proBNP levels, MLHFQ total scores, and SAS total scores were correlated with poorer nutritional status (all p < 0.05). CONCLUSION: The prevalence of anxiety symptoms was high among elderly heart failure patients. Anxiety levels were significantly correlated with worse NYHA grading, elevated NT-proBNP and LDL-C, and poorer nutritional status. There was a strong negative correlation between anxiety and nutritional status, and these three indicators were simultaneously linked to unfavourable heart failure progression. Based on the observed correlational relationships, integrated psychological and nutritional assessment and intervention are recommended for elderly patients with heart failure in clinical practice. This cross-sectional study can only identify correlational associations rather than causal relationships; prospective cohort studies are required to clarify the directional interactions among heart failure severity, anxiety and nutritional status.