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Depressive symptoms and risk of functional decline and death in patients with heart failure
V Vaccarino1, S V Kasl, J Abramson
1Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, Georgia 30306, USA. lvaccar@ecor.cardio.emory.edu
Insights
Depressive symptoms are linked to a worse prognosis in heart failure patients. More severe symptoms correlate with a higher risk of functional decline or death within six months.
Area of Science:
- Cardiology
- Psychiatry
- Gerontology
Background:
- Depression is a known risk factor for adverse outcomes in coronary heart disease.
- The prognostic role of depression in heart failure patients remains less understood.
Purpose of the Study:
- To investigate the association between depressive symptoms and prognosis in patients diagnosed with heart failure.
Main Methods:
- Prospective follow-up of 391 patients aged 50 years or older admitted for decompensated heart failure.
- Assessed outcomes of death or decline in activities of daily living (ADL) at six months.
- Measured depressive symptom severity using the Geriatric Depression Scale, Short-Form.
Main Results:
- A significant, graded relationship was observed between the severity of depressive symptoms and the combined endpoint of functional decline or death.
- Patients with severe depressive symptoms (≥11) faced an 82% increased risk of functional decline or death compared to those with fewer symptoms (<6), after adjusting for covariates.
- A similar trend was noted for functional decline and mortality individually, though the association with mortality alone was not statistically significant after multivariate analysis.
Conclusions:
- Increased depressive symptoms serve as a negative prognostic indicator for individuals with heart failure.
- This finding parallels the established role of depression as a negative prognostic factor in coronary heart disease.
Objectives:
We sought to examine whether depressive symptoms are associated with poorer prognosis in patients with heart failure.
Background:
Depression is an established risk factor for poor outcome in patients with coronary heart disease (CHD). Little is known of its role in patients with heart failure.
Methods:
We prospectively followed 391 patients > or =50 years of age who met criteria for decompensated heart failure on hospital admission. The outcome of the study was death or decline in activities of daily living (ADL) at six months, relative to baseline. Depressive symptoms were measured at baseline by means of the Geriatric Depression Scale, Short-Form, with 6 to 7 symptoms, 8 to 10 symptoms and > or =11 symptoms indicating mild, moderate and severe levels of depressive symptoms, respectively.
Results:
There was a strong and graded association between the severity of depressive symptoms at baseline and the rate of the combined end point of either functional decline or death at six months. After adjustment for demographic factors, medical history, baseline functional status and clinical severity, patients with > or =11 depressive symptoms, compared with those with <6 depressive symptoms, had an 82% higher risk of either functional decline or death, whereas the intermediate levels of depressive symptoms showed intermediate risk (p = 0.003 for trend). A similar graded association was found for functional decline and death separately; however, after multivariate analysis, the association with mortality was less strong and no longer statistically significant.
Conclusions:
An increasing number of depressive symptoms is a negative prognostic factor for patients with heart failure, just as it is for patients with CHD.