Depression predicts mortality and hospitalization in heart failure: A six-years follow-up study

Abstract

Background

The aim of this study is to evaluate the prevalence of depressive symptoms (DS) and its relation on hospitalization for cardiovascular (CV) causes and all-cause mortality risk among outpatients with HF.

Methods

A prospective study was conducted on 130 adult outpatients with HF. The Beck Depression Inventory Scale–second edition (BDI–II) was used to screen for DS. All-cause mortality and hospitalization for CV causes were registered over 6 years. Logistic regression and multinomial logistic regression analysis were used to evaluate the independent prognostic value of DS on mortality and hospitalization for CV causes after adjustment for clinical risk factors.

Results

During a mean follow-up of 6 years, 44% of patients were classified as having DS. Sixty-two participants died for all causes, representing 61% of those with DS and 37% of those without (p=0.006); Forty-nine participants (38%) were hospitalized for CV causes, representing 49% of those with DS and 29% of those without (p=0.027).

Logistic regression analysis indicated that DS predicted all-cause mortality (OR: 2.905; 95% CI:1.228–6.870; p=0.006) and multinomial logistic regression indicated that DS were predictive of hospitalization for CV causes (OR: 3.169; 95% CI: 1.230–8.164; p=0.027). These associations were independent of conventional risk factors.

Limitations

Only outpatient sample; measure of DS only at baseline; cause of death was not known.

Conclusion

This study, first held in a portuguese population, showed that DS are independent predictors of death and hospitalization for CV causes among HF patients and its impact persists over 6 years.

Introduction

Heart failure (HF) is a serious and progressive medical condition associated with high mortality, morbidity and reduced quality of life (Johansson et al., 2006, Rosamond et al., 2008; The CONSENSUS trial study group, 1987; The SOLVD investigators, 1990). Depression is a common co-morbidity in these patients (Abramson et al., 2001, Joynt et al., 2004, Pelle et al., 2008, Rutledge et al., 2006) and in some studies has been associated with adverse outcomes, as increased risk of hospitalizations (Faris et al., 2002, Jiang et al., 2001, Rozzini et al., 2002); increased health costs (Koenig et al., 1998); functional decline (Rumsfeld et al., 2003, Vaccarino et al., 2001) and death (Sokoreli et al., 2016). The additional effect of depression on mortality in HF has been demonstrated in many studies over periods from 3 months to 3 years (short term effect) however, the long-term effect of depression on clinical outcome among these patients is not well known due to the high mortality verified within 5 years (Adams et al., 2012). Besides that, compared with the end point of mortality, there have been fewer studies evaluating the impact of depression on the end point of hospitalization for CV causes after adjusting for HF severity (in particular using the plasma B-type natriuretic peptide- BNP) and other prognostic factors (Faris et al., 2002; Januzzi, 2013; Jiang et al., 2001; Murberg and Furze, 2004).

Depression may contribute to poor outcome via adverse effects on health behaviour, including smoking, physical inactivity and nonadherence to prescribed treatment plans (Joynt et al., 2003); it has been related to reduced heart rate variability (Carney et al., 2001); blunted baroreflex sensitivity (Watkins and Grossman, 1999); heightened sympathetic nervous system activity (Hughes et al., 2004); blood hypercoagulability (Von Kanel et al., 2001); increased inflammation (Kop et al., 2002) and endothelial dysfunction (Sherwood et al., 2005). Each of these disease pathways may act independently or synergistically to increase risk in patients with HF (Sherwood et al., 2007).

The purpose of this study was to evaluate, in a portuguese population, whether DS independently predict long-term mortality due to all-causes or hospitalization for CV causes after adjustment for HF severity and other conventional risk factors of prognosis.