The Prevalence of depression in outpatients attending a chronic heart failure with reduced ejection fraction clinic in a tertiary academic centre in Johannesburg, South Africa

Background: In high income countries depression is reported to affect at least one-fifth of patients with chronic heart failure (CHF). Mental health problems have been associated with frequent rehospitalisation and an increased risk of all-cause mortality. Despite the reported high prevalence of depression in CHF, there is a paucity of data on this subject from the developing world. The aim of the study was to determine the prevalence of depression, stress and anxiety in patients attending a dedicated chronic heart failure clinic. Methods: A prospective study was conducted at an outpatient heart failure clinic, in a tertiary academic centre over a nine month period in 2016. The study participants completed a Depression, Anxiety and Stress (DASS-21) questionnaire to screen for the presence and severity of depression, anxiety and stress. Descriptive statistics and logistic regression analysis was used to identify predictors of depression.Results: The study population comprised of 103 patients, predominantly female (62.1%) with a median age of 53 (interquartile range 38 – 61). Hypertension was the most common co-morbidity, reported in 35.9% of patients. Depression was reported by 54 (52.4%) with 12(11.7%) reporting extremely severe depression. Anxiety was diagnosed in 55 (53.4%) patients with extremely severe anxiety reported by 19 (18.4%) patients. Fifty patients (48.5%) were classified as stressed and only 8 (7.7%) had extremely severe stress. More than half of the patients (54.4%) were in New York Heart Association (NYHA) functional class I with a mean (SD) left ventricular ejection (LVEF) of 30.5 (11.1) %. The six-minute walk test (odds ratio (OR) -0.07, 95% confidence interval (CI) -0.01 – 0.00, p=0.012) and the Minnesota Living with Heart Failure score (OR 0.04, CI 0.02 – 0.01, p=0.001) were identified as independent predictors of depression. Conclusion: The prevalence of depression and anxiety was found in over half of our patients attending the chronic heart failure clinic. In view of the high prevalence of psychosocial stressors in CHF, we recommend that mental health screening should be considered. Prospective, adequately powered, multicentre studies from developing countries investigating the impact of depression on heart failure hospitalisation and mortality are still required.