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Depression is common and precludes accurate assessment of functional status in elderly patients with congestive heart
C E Skotzko1, C Krichten, G Zietowski
1Department of Psychiatry, University of Medicine and Dentistry New Jersey, Robert Wood Johnson Medical School, New Brunswick 08901, USA.
Insights
Depression is common in congestive heart failure (CHF) patients and may lead them to underestimate their physical abilities. Objective energy expenditure was similar between depressed and nondepressed CHF groups.
Area of Science:
- Cardiology
- Psychiatry
- Gerontology
Background:
- Congestive heart failure (CHF) and depression independently cause physical decline.
- The link between depressive symptoms and physical limitations in CHF patients is not well understood.
Purpose of the Study:
- To investigate the prevalence of depressive symptoms in elderly CHF patients.
- To examine the relationship between depression and objective physical limitations in CHF.
Main Methods:
- Assessed depressive symptoms using the Center for Epidemiological Studies Depression Scale (CES-D).
- Measured functional status via self-report, cardiopulmonary exercise testing (CPX), and energy expenditure (doubly labeled water, Caltrac).
- Compared depressed (CES-D ≥ 16) and nondepressed CHF patient groups.
Main Results:
- 42% of CHF patients exhibited depressive symptoms.
- No demographic or illness severity differences were found between groups.
- Depressed patients reported worse physical functioning but had comparable energy expenditure and VO2max; they showed less exertion (lower respiratory quotient) during CPX.
Conclusions:
- Depressive symptoms are prevalent in CHF and not linked to CHF severity.
- Depressed CHF patients may underestimate their functional capacity, potentially leading to inaccurate assessments.
- Objective energy expenditure is similar, but perceived function differs between depressed and nondepressed CHF patients.
Background:
Congestive heart failure (CHF) and depression are independently known to result in physical decline and diminished functional capacity in the general population. The prevalence and relationship of depressive symptoms in CHF to physical limitations has not been objectively examined.
Methods And Results:
The Center for Epidemiological Studies Depression Scale (CES-D) was used to ascertain depressive symptoms in 33 elderly ambulatory individuals with CHF. Self-report assessment of functional status, cardiopulmonary exercise testing (CPX), and measurement of energy expenditure by doubly labeled water and Caltrac Accelerometer (Muscle Dynamics, Torrance, CA) were performed. Depressed and nondepressed groups were compared. Forty-two percent of the patients scored in the depressed range (CES-D score of 16 or greater). There were no differences in demographic variables or severity of illness between the depressed and nondepressed patients. Energy expenditure was comparable across groups. Although obtaining similar maximal heart rate and maximal oxygen consumption (VO2max) on CPX, the depressed group showed less exertion on exercise testing with a significantly lower respiratory quotient (P = .017).
Conclusion:
Depressive symptoms were common and unrelated to the severity of CHF. Although depressed individuals tended to report worse physical functioning than nondepressed individuals, objective assessment of energy expenditure was comparable. Depressed patients appear to underestimate their functional ability. Subsequently, inaccurate assessment of functional status may occur.