February 26, 2007Archives of Internal Medicine343 citations
Relationship of Depression to Death or Hospitalization in Patients With Heart Failure
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Key Result
Clinically significant symptoms of depression in heart failure patients were associated with an increased risk of death or cardiovascular hospitalization (HR 1.56; 95% CI 1.07-2.29).
Key Points
- This study investigates how depression affects the death and hospitalization rates among heart failure patients, independent of disease severity.
- Evaluated 204 outpatients with heart failure and ejection fraction ≤ 40%.
- Assessed depressive symptoms using the Beck Depression Inventory and heart failure severity by N-terminal pro-B-type natriuretic peptide.
- Applied Cox proportional hazards regression to analyze the association between depression and combined endpoints of death or cardiovascular hospitalization.
- Symptoms of depression were associated with an increased risk of death or hospitalization (P<.001).
- Clinically significant depression (score ≥10) corresponded to a hazard ratio of 1.56 (95% CI, 1.07-2.29) for death or hospitalization.
- Antidepressant use was linked to a higher likelihood of adverse outcomes with a hazard ratio of 1.75 (95% CI, 1.14-2.68, P=0.01).
Study Design
Type
Cohort (n=204)
Structured PICO
Do depressive symptoms or antidepressant medication use increase the risk of death or cardiovascular hospitalization in outpatients with heart failure?
P
Population
204 outpatients with heart failure and LVEF ≤40%, followed for a median of 3 years.
E
Exposure
Clinically significant symptoms of depression (Beck Depression Inventory score ≥10) or antidepressant medication use
C
Comparator
Absence of clinically significant depressive symptoms (Beck Depression Inventory score <10) or no antidepressant medication use
O
Outcome
Combined end point of death and hospitalizations because of cardiovascular disease at median 3 years follow-upcomposite
In outpatients with HFrEF, clinically significant depressive symptoms and antidepressant medication use are independently associated with an increased risk of death or cardiovascular hospitalization.
Main Result
Hazard Ratio: 1.56 (95% CI 1.07–2.29)
p-value: p=<.001
Abstract
BACKGROUND: Depression is widely recognized as a risk factor in patients with coronary heart disease. However, patients with heart failure (HF) have been less frequently studied, and the effect of depression on prognosis, independent of disease severity, is uncertain. METHODS: Two hundred four outpatients having a diagnosis of HF, with a ventricular ejection fraction of 40% or less, underwent baseline assessments including evaluation of depressive symptoms using the Beck Depression Inventory and of HF severity determined by plasma N-terminal pro-B-type natriuretic peptide. Cox proportional hazards regression analyses were used to examine the effects of depressive symptoms on a combined primary end point of death and hospitalizations because of cardiovascular disease (hereafter referred to as cardiovascular hospitalization) during a median follow-up of 3 years. RESULTS: Symptoms of depression (Beck Depression Inventory score) were associated with risk of death or cardiovascular hospitalization (P/=10) were associated with a hazard ratio of 1.56 (95% confidence interval, 1.07-2.29) for the combined end point of death or cardiovascular hospitalization. Contrary to our expectation, antidepressant medication use was associated with increased likelihood of death or cardiovascular hospitalization (hazard ratio, 1.75; 95% confidence interval,1.14-2.68, P =.01) after controlling for severity of depressive symptoms and for established risk factors. CONCLUSIONS: Symptoms of depression were associated with an adverse prognosis in patients with HF after controlling for HF severity. The unexpected association of antidepressant medications with worse clinical outcome suggests that patients with HF requiring an antidepressant medication may need to be monitored more closely.
Cite This Study
Andrew Sherwood (2007) conducted a cohort in Heart failure (n=204). Clinically significant symptoms of depression vs. No clinically significant symptoms of depression was evaluated on Combined end point of death and hospitalizations because of cardiovascular disease (HR 1.56, 95% CI 1.07-2.29, p=<.001). Clinically significant symptoms of depression in heart failure patients were associated with an increased risk of death or cardiovascular hospitalization (HR 1.56; 95% CI 1.07-2.29).