Related Experiment Video
Updated: Sep 29, 2025
Author Spotlight: Unveiling the Connection Between Sleep Disorders and Cognitive Symptoms in Depression
Published on: April 26, 2024
Depressive Symptoms and Incident Hospitalization for Heart Failure: Findings From the REGARDS Study
Yulia Khodneva1, Parag Goyal2,3, Emily B Levitan4
1Department of Medicine School of Medicine University of Alabama at Birmingham AL.
Insights
Depressive symptoms are linked to heart failure hospitalizations, particularly HFpEF, in adults without prior coronary heart disease. This association was not found for HFrEF or in those with existing CHD.
Area of Science:
- Cardiology
- Psychiatry
- Epidemiology
Background:
- Depressive symptoms are established risk factors for coronary heart disease (CHD).
- The association between depressive symptoms and incident heart failure (HF), including its subtypes, remains unclear.
- Understanding this link is crucial for comprehensive cardiovascular disease prevention and management.
Purpose of the Study:
- To investigate the association between depressive symptoms and incident heart failure (HF) hospitalizations.
- To examine if this association differs for HF with preserved ejection fraction (HFpEF) versus HF with reduced ejection fraction (HFrEF).
- To determine if baseline coronary heart disease (CHD) modifies the relationship between depressive symptoms and incident HF.
Main Methods:
- Analysis of 26,268 HF-free participants from the REGARDS study (US adults ≥45 years).
- Baseline depressive symptoms assessed using the Center for Epidemiologic Studies Depression scale (score ≥4).
- Incident HF hospitalizations adjudicated and classified as HFpEF (EF ≥50%) or HFrEF (EF <50%).
Main Results:
- Higher incidence rates of HF hospitalization observed in participants with depressive symptoms (4.9/1000 person-years) versus those without (3.2/1000 person-years).
- Depressive symptoms were associated with increased risk of HFpEF hospitalization (HR 1.48) in individuals without baseline CHD after covariate adjustment.
- No significant association found between depressive symptoms and incident HFrEF hospitalizations or any HF hospitalization in those with baseline CHD.
Conclusions:
- Depressive symptoms are associated with incident HFpEF hospitalizations among individuals without prior CHD.
- The association between depressive symptoms and heart failure hospitalization is subtype-specific (HFpEF) and dependent on baseline CHD status.
- These findings highlight the importance of addressing depressive symptoms in cardiovascular risk assessment, particularly for HFpEF prevention in at-risk populations.
Abstract:
Background Depressive symptoms are risk factors for several forms of cardiovascular disease including coronary heart disease (CHD). However, it is unclear whether depressive symptoms are associated with incident heart failure (HF), including hospitalization for HF overall or by subtype: HF with preserved (HFpEF) or reduced ejection fraction (HFrEF). Methods and Results Among 26 268 HF-free participants in the REGARDS (Reasons for Geographic And Racial Differences in Stroke) study, a prospective biracial cohort of US community-dwelling adults ≥45 years, baseline depressive symptoms were defined as a score ≥4 on the 4-item Center for Epidemiologic Studies Depression scale. Incident HF hospitalizations were expert-adjudicated and categorized as HFpEF (EF ≥50%) and HFrEF, including mid-range EF (EF<50%). Over a median of 9.2 [IQR 6.2-10.9] years of follow-up, there were 872 incident HF hospitalizations, 526 among those without CHD and 334 among those with CHD. The age-adjusted HF hospitalization incidence rates per 1000 person-years were 4.9 (95% CI 4.0-5.9) for participants with depressive symptoms versus 3.2 (95% CI 3.0-3.5) for those without depressive symptoms (P<0.001). For overall HF, the elevated risk became attenuated after controlling for covariates. When HFpEF was assessed separately, depressive symptoms were associated with incident hospitalization after controlling for all covariates (hazard ratio [HR] 1.48, 95% CI 1.00-2.18) among those without baseline CHD. In contrast, depressive symptoms were not associated with incident HFrEF hospitalizations. Conclusions Among individuals free of CHD at baseline, depressive symptoms were associated with incident hospitalization for HFpEF, but not for HFrEF, or among those with baseline CHD.
Related Concept Videos
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:21Rheumatic Heart Disease III: Medical Management
01:17Pathophysiology of Heart Failure
01:26Heart Failure III: Clinical Manifestations
01:27Heart Failure I: Introduction
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies