Depression and risk of hospital readmission in older patients with heart failure: a systematic review and meta-analysis

Background: Depression is common among patients with heart failure (HF) and may adversely affect clinical outcomes. However, its association with hospital readmission in older patients with HF remains incompletely understood. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, Embase, Web of Science, CNKI, and Wanfang databases were searched from inception to 31 December 2025. Cohort studies examining the association between depression and readmission outcomes in patients with HF were included. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Results: A total of 29 studies were included, of which 13 were eligible for meta-analysis. Depression was associated with a significantly increased risk of readmission and adverse outcomes (HR = 1.76, 95% CI: 1.30-2.40). In studies using continuous measures, higher depressive symptom scores were also associated with increased risk (HR = 1.04, 95% CI: 1.02-1.07). Subgroup analyses suggested a stronger association in studies with longer follow-up, although between-group differences were not statistically significant. Sensitivity analyses confirmed the robustness of the findings. Conclusions: Depression is associated with an increased risk of readmission in patients with heart failure. Routine assessment of depressive symptoms may improve risk stratification and support targeted post-discharge management, particularly in older populations.