Prognostic Value of Depressive Symptoms for Cardiovascular Events in Female Patients With Heart Failure With Reduced
Hengli Zhao1, Jiaxue Jiang2, Guoheng Zhong3
1Guangdong Provincial Key Laboratory of Clinical Pharmacology Medical Research Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou China.
Insights
Depression significantly impacts cardiovascular death risk in women with heart failure (HF). Changes in depression severity predict outcomes in HF with preserved ejection fraction, while baseline depression is key for HF with reduced ejection fraction.
Area of Science:
- Cardiology
- Psychiatry
- Clinical Research
Background:
- Women with heart failure (HF) experience higher rates of depression compared to men.
- Limited research exists on the specific outcomes for female HF patients experiencing depressive symptoms.
Purpose of the Study:
- To investigate the prognostic value of depressive symptoms and their changes over time in female patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).
- To determine the association between depression severity and cardiovascular death in these patient populations.
Main Methods:
- Secondary analysis of 506 female patients with HFpEF (TOPCAT cohort) and 439 female patients with HFrEF (HF-ACTION cohort).
- Depressive symptoms assessed using Patient Health Questionnaire-9 and Beck Depression Inventory-II, categorized by severity.
- Multivariable Cox proportional hazards models used to determine the prognostic value of baseline depression and changes in depression class.
Main Results:
- In HFpEF patients, both 12-month depression class and change in depression class were significant predictors of cardiovascular death (HRs 1.43 and 1.71, respectively).
- In HFrEF patients, both baseline depression class and change in depression class significantly predicted cardiovascular death (HRs 3.30 and 2.21, respectively).
- The prognostic impact of depressive assessments on hospitalization in HF patients remains unclear.
Conclusions:
- For women with HFrEF, baseline depression severity is the strongest predictor of cardiovascular death.
- For women with HFpEF, the change in depression severity over time shows a more significant prognostic trend for cardiovascular death.
- Depression management may be crucial for improving cardiovascular outcomes in women with heart failure.
Background:
Among those with heart failure (HF), women are more likely to develop depression than men. Few studies have focused on the outcomes of female patients with HF with depressive symptoms.
Methods And Results:
A total of 506 female patients with HF with preserved ejection fraction were included in this secondary analysis from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) cohort, and 439 female patients with HF with reduced ejection fraction were included from the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) cohort. Depressive symptoms were measured using the Patient Health Questionnaire-9 and Beck Depression Inventory-II. The depression class was categorized by severity, and the change in clinical depression class was defined as aggravated (1-grade increase) or improved (1-grade decrease). The prognostic value of depressive symptoms was determined by using multivariable Cox proportional hazards models. Female patients with improved depressive symptoms had worse depressive status at baseline and lower baseline Kansas City Cardiomyopathy Questionnaire scores. Depression class at the 12-month visit and depression class change were the dominant prognostic factors for cardiovascular death in female patients with HF with preserved ejection fraction (hazard ratio [HR], 1.43 [95% CI, 1.02-2.01], P=0.036; HR, 1.71 [95% CI, 1.14-2.55], P=0.009). Among the patients with HF with reduced ejection fraction, both the depression class at baseline and depression class change had significant prognostic effects on cardiovascular death (HR, 3.30 [95% CI, 1.70-6.39], P<0.001; HR, 2.21 [95% CI, 1.28-3.80], P=0.004). However, the prognostic value of depressive assessments for hospitalization in patients with HF is unclear.
Conclusions:
In female patients with HF with reduced ejection fraction, the depression class at baseline was most strongly associated with cardiovascular death, whereas in female patients with HF with preserved ejection fraction, the change in depression class exhibited a more significant prognostic trend.
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