A longitudinal study of changes in depressive symptoms and risk factors for congestive heart failure
Julia Gallucci1,2, Justin Ng1,2, Maria T Secara1,2
1Institute of Medical Science, University of Toronto, Toronto, Canada.
Insights
Depression in congestive heart failure (CHF) patients varies, with quality of life and heart failure severity predicting outcomes. Understanding these patterns aids in targeted CHF patient care.
Area of Science:
- Cardiology
- Psychiatry
- Global Health
Background:
- Depression is common in congestive heart failure (CHF) patients, linked to higher mortality and healthcare use.
- Most research on depression and CHF is from high-income countries, creating a knowledge gap for low-to-middle-income countries.
Purpose of the Study:
- To identify changes in depressive symptoms among patients with congestive heart failure (CHF).
- To determine risk factors associated with poor outcomes in CHF patients with varying depressive symptom trajectories.
Main Methods:
- Longitudinal study of 783 CHF patients in Karachi, Pakistan.
- Assessed depressive symptom severity using the Beck Depression Inventory (BDI) at baseline and 6 months.
- Utilized Gaussian mixture modelling for symptom clustering and a random forest algorithm for predictor identification.
Main Results:
- Identified four depressive symptom trajectories: 'good prognosis', 'remitting course', 'clinical worsening', and 'persistent course'.
- Poorer quality of life and New York Heart Association (NYHA) class 3 symptoms correlated with persistent depressive symptoms.
- Less disability and absence of NYHA class 3 symptoms were associated with a good prognosis.
Conclusions:
- Examining depressive symptom progression in CHF patients enhances understanding of influencing factors.
- Identifies specific patient subgroups requiring closer monitoring and tailored follow-up care for improved management.
Background:
Depression is prevalent among patients with congestive heart failure (CHF) and is associated with increased mortality and healthcare use. However, most research on this association has focused on high-income countries, leaving a gap in knowledge regarding the relationship between depression and CHF in low-to-middle-income countries.
Aims:
To identify changes in depressive symptoms and potential risk factors for poor outcomes among CHF patients.
Methods:
Longitudinal data from 783 patients with CHF from public hospitals in Karachi, Pakistan, were analysed. Depressive symptom severity was assessed using the Beck Depression Inventory. Baseline and 6-month follow-up Beck Depression Inventory scores were clustered using Gaussian mixture modelling to identify separate depressive symptom subgroups and extract trajectory labels. Further, a random forest algorithm was used to determine baseline demographic, clinical and behavioural predictors for each trajectory.
Results:
Four separate patterns of depressive symptom changes were identified: 'good prognosis', 'remitting course', 'clinical worsening' and 'persistent course'. Key factors related to these classifications included behavioural and functional factors such as quality of life and disability, as well as the clinical severity of CHF. Specifically, poorer quality of life and New York Heart Association (NYHA) class 3 symptoms were linked to persistent depressive symptoms, whereas patients with less disability and without NYHA class 3 symptoms were more likely to exhibit a good prognosis.
Conclusions:
By examining the progression of depressive symptoms, clinicians can better understand the factors influencing symptom development in patients with CHF and identify those who may require closer monitoring and appropriate follow-up care.
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