Depression and anxiety as predictors of mortality among heart failure patients: systematic review and meta-analysis

Abstract

Several studies suggest that psychological factors are associated with negative outcomes and in particular higher mortality rates among heart failure (HF) patients. We aimed to evaluate the effect sizes of depression and anxiety on all-cause mortality in HF patients. We conducted a systematic review according to the PRISMA methodology. We searched for studies on depression or anxiety effects on all-cause mortality among HF patients published up to June 2015. A number of 26 and 6 articles met inclusion criteria for depression (total 80,627 patients) and anxiety (total 17,214 patients), respectively. The effect estimates were pooled using random-effect meta-analysis. Depression has significant and moderately heterogeneous effect on all-cause mortality (HR = 1.57; 95%CI 1.30-1.89, p < 0.001); adjustment for confounders led to a similar effect estimate (HR = 1.40; 95%CI 1.22-1.60; p < 0.001). Larger studies and higher study prevalence of depression were associated with smaller effect size. The effect of anxiety on mortality outcome was small and not conclusive given the low number of studies (n = 6) (HR = 1.02; 95% CI 1.00-1.04, p < 0.05). This systematic review and meta-analysis suggests that depression is an important and independent predictor of all-cause mortality among HF patients, while anxiety does not appear to have a strong effect. Further research is recommended toward the detection and treatment of depression.

Depression as an independent prognostic factor for all-cause mortality after a hospital admission for worsening heart failure

“…For patients with HF, depression is associated with an increased rate of adverse outcomes 2,3 , such as hospitalization and death. The aggregated risk-estimate derived from 26 studies was an approximately 1.5-fold risk of death in patients with HF if they had depression (3).…”

“…The aggregated risk-estimate derived from 26 studies was an approximately 1.5-fold risk of death in patients with HF if they had depression (3). However, it can be difficult to disentangle whether depression causes a worse outcome, or merely reflects worse HF or more severe co-morbidity.…”

Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

“…Mental comorbidities such as depressive and anxiety disorders are common in patients with CHF. Depressive comorbidities are present in about 20% of patients, anxiety comorbidities in up to 40% [119].…”

Is the Brain the Alternative Therapeutic Target for Heart Failure?

“…The latest systematic review and meta-analysis reveal prevalence rates of depression and cognitive dysfunction as 29% (10-79%) and 30-80%, respectively, and both are independent predictors of mortality and rehospitalization among HF patients. 3 Recently, it was reported that reduced global CBF predicts depressive symptoms and cognitive dysfunction, and worse outcomes. 4,5 Global CBF is evaluated by transcranial Doppler ultrasonography, radionuclide angiography and magnetic resonance imaging (MRI) (Figure).…”