Is there an important role for anxiety and depression in the elderly patient with critical limb ischemia, especially after major amputation?

In critical limb ischemia patients, an association is assumed between depression and worse outcome for morbidity, such as major limb amputation. After major amputation, anxiety and depression are common. We aimed to determine the association of depressive and anxiety symptoms in the elderly with critical limb ischemia, especially after major limb amputation. Critical limb ischemia patients aged ≥70 years were included in this prospective observational cohort study between January 2012 and February 2016 in two Dutch hospitals. After a multidisciplinary vascular conference, patients were divided into four treatment groups: endovascular revascularisation, surgical revascularisation, conservative therapy, or primary major amputation. In a one-year follow-up period, depression and anxiety were measured four times using the Dutch versions of the Center for Epidemiological Studies Depression Scale and the State-Trait Anxiety Inventory. 187 patients were included. Within one year, 44 patients underwent a major limb amputation. Lower amputation free survival did not differ significantly for patients with versus without greater anxiety (X (1)=0.689, p=0.407), and also not for patients with versus without more depressive symptoms (X (1)=0.614, p=0.433). For both groups, there were no significant changes in anxiety scores over time. After a median follow-up time of 336.5 days and 365 days, depressive symptoms significantly decreased in amputees, respectively 8.5 vs. 4.5 ((95% CI 1.76-7.48), p=0.002) and 8.5 vs. 4.3 ((95% CI 0.61-9.82), p=0.027) when compared to the baseline measurement. Similarly, non-amputees had significantly lower overall score for depressive symptoms after a median follow-up time of 365 days (10.1 vs. 4.1, (95% CI 4.49-6.90), p