Clinical Investigation
Congestive Heart Failure
Relationship between depressive symptoms and long-term mortality in patients with heart failure

https://doi.org/10.1016/j.ahj.2007.03.043Get rights and content

Background

Depression is prevalent in patients with heart failure (HF) and is associated with short-term poor prognosis. However, the long-term effect of depression and the use of self-administered depression evaluation on HF prognosis remained unknown. The study sought to assess the association of depressive symptoms and long-term mortality of patients with HF and to explore the prognostic predictability of the Beck Depression Inventory (BDI) scale for patients with HF.

Methods

Hospitalized patients with HF between March 1997 and June 2003 were recruited. All participants were given the self-administered BDI scale for depression assessment during the index admission. They were then followed for 6 months for the collection of vital status, and annually thereafter.

Results

Total study population comprises 1006 patients. The mean BDI score was 8.3 ± 7.1. The average days of follow-up were 971 ± 730 and the vital status was obtained from all participants. During this period, 42.6% of the participants died. Depression (defined by BDI score ≥10) was significantly and independently associated with reduced survival (adjusted hazard ratio 1.36, 95% CI 1.09-1.70, P < .001). Patients whose BDI scores were 5 to 9, 10 to 18, and ≥19 were 21%, 53%, and 83% more likely to die, respectively, than patients whose BDI score was <5 (P < .001).

Conclusions

Self-rated depression by BDI is independently linked with higher long-term mortality in patients with HF. Significant dose effect of depressive symptoms on higher mortality is noted.

Section snippets

Subjects

The study was approved by the Duke University Health System Institutional Review Board and conducted at the Duke University Medical Center, Durham, NC. The study participants were recruited from the adult patients ≥18 years old who were admitted to the cardiology service at Duke University Medical Center between March 1997 and June 2003. Patients were eligible for enrollment if they had clinically diagnosed HF, defined as New York Heart Association (NYHA) class ≥II, an ejection fraction of ≤35%

Patient characteristics and follow-up information

The study population consisted of 1006 patients with HF. Approximately 34.6% of the participants were admitted because of HF exacerbation. The rest of the participants were admitted for other reasons, such as chest pain due to MI or unstable angina, arrhythmia, and so on (Table I). On average, the patients were 68 years old. Sixty-two percent were male and 73% were white. Heart failure was of ischemic etiology present in 62% of the participants, and 41% of the study population had had an MI

Discussion

In these patients with HF, self-rated measurement of depression defined by BDI scores ≥10 significantly predicted mortality an average of 2.66 ± 2.0 years after index hospitalization. Furthermore, the severity of the self-reported depressive symptoms showed a significant “dose-response” relationship with reduced survival. These negative associations emerged shortly after admission and persisted throughout the follow-up period. Using items of BDI assessing mood and anhedonia only has no

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  • Cited by (0)

    The study was supported in part by National Institutes of Mental Health grants R01MH51191 and R01MH63211-Minority Supplement Award (WJ), and the APIRE/Merck & Co. Early Academic Career Research Award, 2004 (WJ).

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