Depressive symptomatology and NT-proBNP and Health status in Heart Failure

Background: Although depression symptoms are common among heart failure (HF) patients, there is little consensus regarding the relationship between depressive symptoms and NT-proBNP, the key HF marker. Therefore, this study aimed to investigate this relationship and assess the impact of depressive symptoms on the health status and clinical outcomes of HF patients. Methods: 151 patients with HF were enrolled in the study and followed up for one year. Depressive symptoms and health status were assessed by the Hospital Anxiety and Depression Scale (HADS-D) and the Kansas City Cardiomyopathy Questionnaire (KCCQ), respectively. Results: At baseline, the median HADS-D score was 5 (3 - 8) points. Patients with HADS-D scores > 5 points had significantly higher NT-proBNP levels ( p = 0.043), and significantly lower KCCQ-OSS and KCCQ-CSS ( p < 0.001 for both KCCQ scores). From baseline to the last assessment after one year the percentage changes in the HADS-D scores were significantly positively correlated with the percentage changes in the levels of NT-proBNP (r = 0.22, p = 0.009). It was also significantly negatively correlated with the changes in KCCQ-OSS (r = -0.34, p < 0.001) and KCCQ-CSS (r = -0.19, p = 0.021). Moreover, baseline HADS-D score was an independent predictor of the percentage changes in NT-proBNP from baseline to the last assessment (ß = 3.91, p = 0.03), even after adjustment for age, sex, baseline LVEF and creatinine (ß = 3.99, p = 0.02). In a Cox regression analysis baseline HADS-D score had a significant impact on the cardiovascular mortality, which remained consistent even after adjustment for age, sex, and baseline LVEF, NT-proBNP and creatinine (hazard ratio = 1.18, 95% CI = 1.0 – 1.4, p = 0.048). Conclusions: 1. There is a significant correlation between depressive symptoms, NT-proBNP, and health status in HF patients. 2. Baseline HADS-D score has a significant impact on the cardiovascular mortality in HF patients.