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Associations Between Depressive Symptoms and HFpEF-Related Outcomes

Alvin Chandra1, Michael A D Alcala2, Brian Claggett3

  • 1Cardiology Division, University of Texas Southwestern, Dallas, Texas, USA.

JACC. Heart Failure
|September 13, 2020
PubMed

Insights

Higher baseline depressive symptoms in heart failure patients predict mortality. Worsening symptoms also increase mortality risk, while spironolactone may offer some improvement.

Area of Science:

  • Cardiology
  • Psychiatry
  • Clinical Trials

Background:

  • Limited longitudinal data exist on depressive symptoms in heart failure with preserved ejection fraction (HFpEF).
  • Depression is a significant comorbidity in cardiovascular disease, impacting patient outcomes.

Purpose of the Study:

  • To analyze changes in depressive symptoms in HFpEF patients within the TOPCAT trial.
  • To identify predictors of depressive symptom changes and their impact on cardiovascular events and mortality.

Main Methods:

  • 1,431 patients from the US and Canada in the TOPCAT trial had depressive symptoms assessed using the Patient Health Questionnaire-9 (PHQ-9).
  • Clinically meaningful changes were defined as a ≥3-point increase (worse) or decrease (better).
  • Multivariate and Cox proportional hazard models were used to analyze predictors and outcomes.

Main Results:

  • At 12 months, 19% of patients had worsening symptoms, 31% improved, and 49% remained unchanged.
  • Higher baseline PHQ-9, male sex, no COPD, and spironolactone randomization predicted improvement.
  • Higher baseline PHQ-9 predicted all-cause mortality (HR 1.09). Worsening symptoms predicted cardiovascular death (HR 2.47) and all-cause mortality (HR 1.82).
  • Spironolactone was associated with a modest reduction in depressive symptoms (p=0.014).

Conclusions:

  • Elevated baseline and worsening depressive symptoms are linked to increased all-cause mortality in HFpEF patients.
  • Randomization to spironolactone showed a modest but significant association with reduced depressive symptoms.
Abstract

Keywords:
HFpEFTOPCATagedepressionquality of lifespironolactone

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