Depression Predicts Mortality and Hospitalization in Heart Failure
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
The aim of this study is to evaluate the prevalence of depressive symptoms (DS) and its relation on hospitalization for cardiovascular (CV) causes and all-cause mortality risk among outpatients with HF.
METHODS
A prospective study was conducted on 130 adult outpatients with HF. The Beck Depression Inventory Scale-second edition (BDI-II) was used to screen for DS. All-cause mortality and hospitalization for CV causes were registered over 6 years. Logistic regression and multinomial logistic regression analysis were used to evaluate the independent prognostic value of DS on mortality and hospitalization for CV causes after adjustment for clinical risk factors.
RESULTS
During a mean follow-up of 6 years, 44% of patients were classified as having DS. Sixty-two participants died for all causes, representing 61% of those with DS and 37% of those without (p=0.006); Forty-nine participants (38%) were hospitalized for CV causes, representing 49% of those with DS and 29% of those without (p=0.027). Logistic regression analysis indicated that DS predicted all-cause mortality (OR: 2.905; 95% CI:1.228-6.870; p=0.006) and multinomial logistic regression indicated that DS were predictive of hospitalization for CV causes (OR: 3.169; 95% CI: 1.230-8.164; p=0.027). These associations were independent of conventional risk factors.
LIMITATIONS
Only outpatient sample; measure of DS only at baseline; cause of death was not known.
CONCLUSION
This study, first held in a portuguese population, showed that DS are independent predictors of death and hospitalization for CV causes among HF patients and its impact persists over 6 years.
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Additional Info
Disclosure statements are available on the authors' profiles:
Depression Predicts Mortality and Hospitalization in Heart Failure: A Six-Years Follow-Up Study
J Affect Disord 2016 Sep 01;201(xx)162-170, S Ramos, J Prata, P Bettencourt, FR Gonçalves, R CoelhoFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
In the history of medicine, the heart has been viewed as far more than a complex anatomical structure. It was once considered the source of intelligence, the organ representing the soul, and, very frequently, the seat of emotions.
The current study adds to a strong line of evidence-based reports in the past decade that indeed suggest a strong connection between the heart and one’s emotional state. But, that research suggests a different direction of impact. Research now convincingly demonstrates that heart failure patients with depression are at a higher risk for mortality and hospital readmission. This study of Portuguese patients hints that the impact of depression is even more extended than previous studies have demonstrated. What is especially important to the busy clinician is that the presence of sub-diagnostic depressive symptoms also exert an effect. The authors hold that depression is an independent predictor of mortality and hospital readmission.
It is quite challenging to address depressive features in heart failure patients. They often accept that depressive features are “par for the course” and that their functional difficulties are due to physical decline. For physicians, diagnosing depression requires a keen attention to how symptoms present because depressive symptoms common to heart failure patients are most often somatic in nature and overlap with the symptoms of the condition, including anhedonia, fatigue, sleep disruption, weight loss, decreased appetite, and psychomotor retardation. Psychological symptoms commonly seen in depressed patients such as decreased self-worth or guilt may not be present. All evidence points to the need to at least screen for depression simply because it is prevalent in these patients.
There is insufficient evidence to recommend specific antidepressants for heart failure patients but both cognitive behavior therapy and pharmacologic interventions have a role. Regardless, the goal of intervention is primarily to enable patients to maintain the highest quality of life possible as they confront the challenges of heart failure. No evidence yet suggests that treatment of depression in these patients reduces hospitalizations or delays mortality.