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