Clinical Investigation
Depression Predicts Repeated Heart Failure Hospitalizations

https://doi.org/10.1016/j.cardfail.2011.12.005Get rights and content

Abstract

Objective

Management of depression, if it is independently associated with repeated hospitalizations for heart failure (HF), offers promise as a viable and cost-effective strategy to improve health outcomes and reduce health care costs for HF. The objective of this study was to assess the association between depression and the number of HF-related hospitalizations in patients with low-to-moderate systolic or diastolic dysfunction, after controlling for illness severity, socioeconomic factors, physician adherence to evidence-based medications, patient adherence to HF drug therapy, and patient adherence to salt restrictions.

Methods and Results

The Heart Failure Adherence and Retention Trial (HART) was a randomized behavioral trial to evaluate whether patient self-management skills coupled with HF education improved patient outcomes. Depression was measured at baseline with the Geriatric Depression Scale (GDS). The number of hospitalizations was analyzed with a negative binomial regression model that included an offset term to account for the differential duration of follow-up for individual subjects. The average unadjusted number of hospitalizations per year was 0.40 in the depressed group (GDS ≥10) and 0.33 in the nondepressed group (GDS <10). Depression was a strong predictor (incident rate ratio 1.45; P = .006) after adjusting for physician adherence to evidence-based medication use, patient adherence to HF drug therapy, patient adherence to salt restriction, illness severity, HF severity (6-minute walk <620 feet), and socioeconomic factors.

Conclusions

Depression is a strong psychosocial predictor of repeated hospitalizations for HF. Compared with nondepressed individuals, those with depression were hospitalized for HF 1.45 times more often, even after controlling for physician adherence to evidence-based medications and patient adherence to HF drug therapy and salt restrictions. This finding suggests that clinicians should screen for depression early in the course of HF management.

Section snippets

Description of HART

The Heart Failure and Retention Trial (HART) was a randomized controlled trial to evaluate the benefit of patient self-management skills training in combination with HF education over HF education alone. Powell et al13 provide a complete description of HART. The HART cohort included 902 participants who were randomized to a self-management intervention or education control and received 18 treatment contacts over 1 year, annual follow-ups, and 3-month phone calls to assess primary end points.

Results

Of the 902 subjects in HART, complete data were available for 784 subjects at baseline, with 14 subjects excluded because they died or were lost to follow-up within the first 60 days after randomization, 71 excluded because of missing 6-minute walk information, and 32 excluded because of missing data on age or income. Table 1 reports the characteristics of the 784 subjects at baseline. The sample was 53% male with an overall average age of 63.1 years (SD 13.2). The majority had an average

Discussion

Depression has been shown to increase the incidence of HF, decrease adherence to prescribed medical treatment, and increase the risk of mortality.4, 5, 6, 7 The present study provides further evidence that depression also increases the risk of costly repeated hospitalizations. Earlier studies on depression and hospitalizations for people with HF primarily examined whether subjects were hospitalized at least once or examined the time to hospitalization, rather than the number of times subjects

Disclosures

None.

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