Worsening depression in HF patients linked to poor prognosis
MedWire News: Heart failure (HF) patients with worsening depression have an increased 5-year risk for cardiovascular (CV)-related hospitalization or death, irrespective of the severity of their heart failure, study results indicate.
"Our findings support the recent American Heart Association position encouraging depression screening, and further suggest that it may be prudent for clinicians to reassess symptoms of depression routinely in HF patients to determine better appropriate medical management of these patients," remark the authors.
Andrew Sherwood (Duke University Medical Center, Durham, North Carolina, USA) and colleagues used the Beck Depressive Inventory (BDI) to assess baseline and 1-year depressive symptoms in 147 HF patients (ejection systolic fraction <40%).
The researchers explain in the Journal of the American College of Cardiology that the 21-item BDI is a self-reporting questionnaire in which a score of 10 or more indicates the presence of clinical depression. An increase in score over time (to a maximum of 63) reflects worsening severity of depression.
After a median follow-up period of 5 years, Sherwood and team found that 36% of patients had died from any cause and 27% had died from a CV-related cause.
Among the whole group, the mean BDI score at baseline was 10 (ranging from 0 to 37), while the change in BDI score at 1 year ranged from a reduction of 14 points to an increase of 19 points.
The severity of baseline depression symptoms significantly correlated with CV-related hospitalization or death with a 10% increase in the risk for either event per 1-point increase in BDI score (p<0.001).
After adjusting for baseline risk factors, such as age and ejection fraction, Sherwood and colleagues noted a 7% increase in risk for CV-related hospitalization or death per 1-point increase in BDI score at 1 year (p=0.007).
Of note, the association between BDI score change and the risk for all-cause hospitalization or death followed a similar trend to that of CV-related hospitalization or death.
No association was found between antidepressant use and adverse clinical outcomes, however.
In a related editorial, Ingrid Connerney (University of Maryland School of Nursing, Baltimore, USA) and Peter Shapiro (Columbia University College of Physicians and Surgeons, New York, USA) commented: "Further studies are needed of the relationship between the course of depression and mortality in HF patients, the mechanisms linking depression to adverse outcomes, and the effects of depression interventions."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Lauretta Ihonor