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Health-related quality of life (HRQOL) and depressive symptoms both are associated with an adverse prognosis in heart failure (HF), although their associations with outcomes have been examined only in isolation. Therefore, it is unknown how HRQOL and depressive symptoms might interact in their associations with outcomes. The present study was conducted to determine whether the association between HRQOL and cardiac event-free survival is mediated by depressive symptoms in HF patients given that depressive symptoms are associated strongly with HRQOL.
A total of 209 HF patients (61 ± 11 years, 24 % female, 49 % NYHA III/IV) participated. The Minnesota Living with HF Questionnaire and the Patient Health Questionnaire-9 were used to measure HRQOL and depressive symptoms, respectively. Patients were followed for a median of 357 days to determine cardiac event-free survival.
In Cox regression analysis, HRQOL [hazard ratio (HR) 1.013; 95 % confidence interval (CI) 1.001–1.026] and depressive symptoms (HR 1.075; 95 % CI 1.025–1.127) predicted cardiac event-free survival separately, controlling for demographic and clinical variables. HRQOL independently explained 38.7 % of the variance in depressive symptoms (p < 0.05; standardized β = 0.695) in a multiple regression. When HRQOL and depressive symptoms were entered in the model simultaneously, only depressive symptoms independently predicted cardiac event-free survival (HR 1.068; 95 % CI 1.001–1.139), demonstrating a mediation effect of depressive symptoms.
Depressive symptoms mediated the relationship between HRQOL and cardiac event-free survival. Interventions targeting HRQOL to enhance patient outcomes must also address patient depressive symptoms to be fully efficacious.
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Heo, S., Lennie, T. A., Okoli, C., & Moser, D. K. (2009). Quality of life in patients with heart failure: Ask the patients. Heart and Lung, 2, 100–108. CrossRef
Lesman-Leegte, I., Jaarsma, T., Coyne, J. C., Hillege, H. L., Van Veldhuisen, D. J., & Sanderman, R. (2009). Quality of life and depressive symptoms in the elderly: A comparison between patients with heart failure and age- and gender-matched community controls. Journal of Cardiac Failure, 15(1), 17–23. PubMedCrossRef
Hobbs, F. D., Kenkre, J. E., Roalfe, A. K., Davis, R. C., Hare, R., & Davies, M. K. (2002). Impact of heart failure and left ventricular systolic dysfunction on quality of life: A cross-sectional study comparing common chronic cardiac and medical disorders and a representative adult population. European Heart Journal, 23(23), 1867–1876. PubMedCrossRef
Parissis, J. T., Nikolaou, M., Farmakis, D., Paraskevaidis, I. A., Bistola, V., Venetsanou, K., et al. (2009). Self-assessment of health status is associated with inflammatory activation and predicts long-term outcomes in chronic heart failure. European Journal of Heart Failure, 11(2), 163–169. PubMedCentralPubMedCrossRef
Moser, D. K., Yamokoski, L., Sun, J. L., Conway, G. A., Hartman, K. A., Graziano, J. A., et al. (2009). Improvement in health-related quality of life after hospitalization predicts event-free survival in patients with advanced heart failure. Journal of Cardiac Failure, 15(9), 763–769. PubMedCentralPubMedCrossRef
Rector, T. S., Kubo, S. H., & Cohn, J. N. (1987). Patients’ self-assessment of their congestive heart failure, Part 2: Content, reliability and validity of a new measure, the Minnesota Living with Heart Failure Questionnaire. Heart Failure, 3, 198–209.
Rector, T. S., & Cohn, J. N. (1992). Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: Reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. American Heart Journal, 124(4), 1017–1025. PubMedCrossRef
Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. The Journal of the American Medical Association, 282(18), 1737–1744. CrossRef
Behlouli, H., Feldman, D. E., Ducharme, A., Frenette, M., Giannetti, N., Grondin, F., et al. (2009) Identifying relative cut-off scores with neural networks for interpretation of the Minnesota Living with Heart Failure questionnaire. In Conference proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Conference, pp. 6242–6246.
Brannstrom, M., Ekman, I., Norberg, A., Boman, K., & Strandberg, G. (2006). Living with severe chronic heart failure in palliative advanced home care. European Journal Cardiovascular Nursing, 5(4), 295–302. CrossRef
Bosworth, H. B., Steinhauser, K. E., Orr, M., Lindquist, J. H., Grambow, S. C., & Oddone, E. Z. (2004). Congestive heart failure patients’ perceptions of quality of life: The integration of physical and psychosocial factors. Aging & Mental Health, 8(1), 83–91. CrossRef
Sun, F., Park, N. S., Roff, L. L., Klemmack, D. L., Parker, M., Koenig, H. G., et al. (2012). Predicting the trajectories of depressive symptoms among southern community-dwelling older adults: The role of religiosity. Aging & Mental Health, 16(2), 189–198. CrossRef
Faller, H., Stork, S., Schuler, M., Schowalter, M., Steinbuchel, T., Ertl, G., et al. (2009). Depression and disease severity as predictors of health-related quality of life in patients with chronic heart failure-A structural equation modeling approach. Journal of Cardiac Failure, 15(4), 286–292. PubMedCrossRef
Huffman, J. C., Mastromauro, C. A., Sowden, G., Fricchione, G. L., Healy, B. C., & Januzzi, J. L. (2011). Impact of a depression care management program for hospitalized cardiac patients. Circulation, 4(2), 198–205. PubMed
Tsutamoto, T., Hisanaga, T., Wada, A., Maeda, K., Ohnishi, M., Fukai, D., et al. (1998). Interleukin-6 spillover in the peripheral circulation increases with the severity of heart failure, and the high plasma level of interleukin-6 is an important prognostic predictor in patients with congestive heart failure. Journal of the American College of Cardiology, 31(2), 391–398. PubMedCrossRef
Paukert, A. L., LeMaire, A., & Cully, J. A. (2009). Predictors of depressive symptoms in older veterans with heart failure. Aging & Mental Health, 13(4), 601–610. CrossRef
Bauer, L. K., Caro, M. A., Beach, S. R., Mastromauro, C. A., Lenihan, E., Januzzi, J. L., et al. (2012). Effects of depression and anxiety improvement on adherence to medication and health behaviors in recently hospitalized cardiac patients. American Journal of Cardiology, 109(9), 1266–1271. PubMedCrossRef
O’Connor, C. M., Jiang, W., Kuchibhatla, M., Silva, S. G., Cuffe, M. S., Callwood, D. D., et al. (2010). Safety and efficacy of sertraline for depression in patients with heart failure: Results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial. Journal of American College Cardiology, 56(9), 692–699. CrossRef
Flynn, K. E., Pina, I. L., Whellan, D. J., Lin, L., Blumenthal, J. A., Ellis, S. J., et al. (2009). Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. The Journal of the American Medical Association, 301(14), 1451–1459. CrossRef
Blumenthal, J. A., Babyak, M. A., O’Connor, C., Keteyian, S., Landzberg, J., Howlett, J., et al. (2012). Effects of exercise training on depressive symptoms in patients with chronic heart failure: The HF-ACTION randomized trial. The Journal of the American Medical Association, 308(5), 465–474. CrossRef
O’Connor, C. M., Whellan, D. J., Lee, K. L., Keteyian, S. J., Cooper, L. S., Ellis, S. J., et al. (2009). Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. The Journal of the American Medical Association, 301(14), 1439–1450. CrossRef
- Depressive symptoms, health-related quality of life, and cardiac event-free survival in patients with heart failure: a mediation analysis
Kyoung Suk Lee
Terry A. Lennie
Martha J. Biddle
Debra K. Moser
- Springer International Publishing