Clinical depression is common and significantly associated with reduced survival in patients with non‐ischaemic heart failure

Abstract

Several studies have shown that depression is an important predictor of morbidity and mortality in patients with ischaemic heart failure. We have investigated whether clinically recognised depression is linked to mortality in patients with non-ischaemic heart failure due to dilated cardiomyopathy (DCM) in the Royal Brompton Hospital (RBH), a tertiary cardiac centre located in London, UK. We retrospectively examined a cohort of 396 consecutive adult patients with DCM who satisfied our inclusion and exclusion criteria identified from an echocardiographic database and the hospital medical records. Mean age was 53"15 years. In all, 83 patients (21%) were clinically depressed, the majority of which (60%) were taking antidepressant therapy. After a follow-up period of 48 months, 83 (21%) patients died, 15 (4%) underwent cardiac transplantation and 130 (33%) were readmitted; 29 (35%) of the deaths and 40 (31%) of the readmissions were among clinically depressed patients. After 5 years, clinically depressed patients had significantly higher mortality and readmission rates than non-depressed; 36 vs. 16% (hazards ratio for death, 3.0; 95% CI, 1.4-6.4; Ps0.004), and 87 vs. 74% (hazards ratio for readmission, 0.25; 95% CI, 0.07-0.90; Ps 0.03), respectively. The risk of depression was greatly increased in the presence of other recognised adverse clinical variables at baseline. Depression increases the risk of death and readmission in patients with heart failure secondary to non-ischaemic DCM. The risk associated with depression appears to be greatest among patients with milder disease, those with a shorter duration of symptoms and those demonstrating a lower systolic or diastolic blood pressure, renal impairment, or a restrictive left ventricular physiology on echocardiography. Interventions targeted at reducing depression warrant further study as a possible way to improve quality of life andyor outcome in patients with heart failure.

Descriptive Epidemiology of Major Depression in Canada

“…Low income, for example, may be a cause or a result of major depression. The association with chronic conditions is important for population health because increased mortality has been associated with depression in various clinical contexts (19)(20)(21)(22), most notably in association with cardiovascular disease (23)(24)(25)(26). Depression can also have a negative impact on treatment adherence (27-30), impairment (31), and The lifetime prevalence data suggests a difference between urban and rural areas (see text).…”

Anger and depression predict hospital use among chronic heart failure patients

“…The results reflect an emerging trend in the literature that suggests that psychological factors are related to the course of CHF, with depression predicting the frequency of readmissions to hospital. [7][8][9][10][11][12][13] The use of a hierarchical regression model has allowed us to provide the first analysis of CHF and hospital use that includes anger, anxiety and depression. Previous research has yielded seven studies that have found a significant relationship between depression and hospital readmissions in the CHF population consistent with the current findings.…”

“…4,6 Examination of these factors has indicated that more severe depression may be significantly associated with or predictive of increased hospital readmissions. [7][8][9][10][11][12][13] The level of depression may also be related to lengthier stays in hospital as suggested by Sullivan et al 8 More studies are required to verify these results, especially those that control for illness severity and include length of stay as an outcome variable.…”

Depressão e infarto agudo do miocárdio

“…Depressão como fator de risco para a doença coronariana e o infarto agudo do miocárdio Vários estudos têm identificado que a depressão se comporta como um fator de risco tanto para o surgimento da doença coronariana como para uma maior morbidade e mortalidade cardiovascular naqueles já portadores de doença cardíaca. A presença de sintomas de ansiedade e /ou depressão após um IAM está associada a maior reincidência de IAM, morte por doença cardíaca, internação prolongada e prejuízo funcional pós-infarto [9][10][11][12][20][21][22] .…”

“…Em um estudo retrospectivo, a presença de depressão clínica em pacientes com IC de origem não coronariana se associou a um risco 25% maior para reinternações e três vezes maior para óbito 10 . De acordo com o Cardiovascular Health Study, a elevada prevalência de sintomas depressivos foi um fator de risco independente para aumento de mortalidade, doença clínica e subclínica 23 e um fator preditivo de eventos cardíacos em até cinco anos após IAM 24,25 .…”