Severe depressive symptoms (≥11 symptoms) were associated with an 82% higher risk of functional decline or death at six months compared to <6 symptoms (p=0.003 for trend).
Cohort (n=391)
Are depressive symptoms associated with an increased risk of functional decline and death in patients with decompensated heart failure?
Increasing severity of depressive symptoms is a strong, graded negative prognostic factor for functional decline or death in older patients hospitalized with decompensated heart failure.
Effect estimate: 82% higher risk
p-value: p=0.003 for trend
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.
“For patients hospitalized for coronary artery disease or heart failure and who had diagnoses of anxiety or depression, treatment with psychotherapy, medication or both was associated with as much as a 75% reduction in hospitalizations or emergency room visits. In some cases, there was a reduction in death.”
Vaccarino et al. (2001) conducted a cohort in decompensated heart failure (n=391). Depressive symptoms vs. <6 depressive symptoms was evaluated on death or decline in activities of daily living (ADL) at six months, relative to baseline (82% higher risk, p=0.003 for trend). Severe depressive symptoms (≥11 symptoms) were associated with an 82% higher risk of functional decline or death at six months compared to <6 symptoms (p=0.003 for trend).