Depression increases the risk of mortality in patients with heart failure: A meta-analysis

https://doi.org/10.1016/j.jpsychores.2017.01.010Get rights and content

Highlights

  • An updated meta-analysis of depression and mortality in HF is presented.

  • Depression is a predictor of all-cause mortality in HF.

  • Stronger effects were found in samples of older adults and with shorter follow-up.

  • Future work should continue to explore depression and cardiac mortality.

Abstract

Background

Depression is a risk factor for mortality in cardiovascular diseases. Prior studies confirm that depression predicts adverse outcomes in patients with heart failure (HF). However, data were inconclusive regarding the effect of depression on mortality. This meta-analysis examines the relationship between depression and mortality in HF.

Methods

Prospective studies of depression and mortality in HF published between 1999 and April 2016 were located using PubMed, PsychINFO, and MEDLINE. Comprehensive Meta-Analysis software was used to compute an aggregated effect size estimates of hazard ratios and to conduct subgroup analyses.

Results

Eighteen studies met inclusion criteria. For 8 aggregated univariate and 14 multivariate estimates, depressive symptoms were related to all-cause mortality. A pooled HR of 3 multivariate analyses indicated that depressive symptoms were not linked to cardiovascular mortality. In subgroup analyses, depression predicted all-cause mortality in samples with a mean age > 65. The impact of depression on all-cause mortality also differed by follow-up duration, with samples with shorter follow-up durations demonstrating a larger effect.

Conclusions

In HF, depression is related to increased all-cause mortality risk, with stronger effects in samples with shorter follow-up and in older adults. In older adults, depression may serve as a marker of more severe HF. However, this possibility is difficult to examine given inconsistent adjustment for HF severity. Additional studies may assist in determining the relationship between depression and cardiovascular mortality, as the low number of studies examining cardiovascular mortality may have precluded detection of an effect.

Section snippets

Depression in heart failure

Within the United States, 5.1 million persons have heart failure (HF) and 825,000 new HF cases are diagnosed each year [1]. Estimates indicate that the prevalence of HF will increase 46% by 2030, so that > 8 million U.S. adults will have HF [2], in part due to the aging population and improved survival rates following MI [3].

Although survival rates have improved substantially, mortality in HF remains high. Fifty percent of HF patients die within five years of diagnosis [4], [5], [6]. The

Present study

Given the increasing prevalence of HF and the severity of the disruptions in the pathophysiology of the cardiovascular system, it is important to determine whether depression conveys similarly added risk in HF as in other presentations of cardiovascular disease such as myocardial infarction. For example, a meta-analysis of 29 studies spanning 25 years revealed that depression is associated with increased risk of cardiac events, cardiac mortality, and all-cause mortality within 24 months of MI [11]

Method

The conduct of this meta-analysis was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [12].

Literature search

A total of 67 studies were identified as potentially relevant to the current analysis based on the title and/or abstract. After review of the full manuscripts, 18 studies met the full inclusion criteria for one or more of the present analyses. See Fig. 1 for a flow diagram of study selection and reasons for exclusion.

Of studies included in the meta-analysis, eight articles were based on studies conducted in the United States, whereas other studies were conducted in Japan (N = 1), the Netherlands (

Discussion

The current meta-analysis investigated the impact of depressive symptoms on all-cause and cardiovascular mortality in HF patients. Compared with a prior meta-analysis on this topic, the current analysis was expanded to include additional reports and provide a more comprehensive look into study characteristics that may create heterogeneity in effect sizes. Four potential moderating variables were examined (age, study location, recruitment setting, and length of follow-up).

Consistent with

Sources of funding

This work was supported by the National Heart, Lung, and Blood Institute [T32 5T32HL076134-10 to R. Wing].

Conflict of interest

The authors have no competing interests to report.

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