February 26, 2007
View Full PaperRelationship of Depression to Death or Hospitalization in Patients With Heart Failure
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).
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.