Depression worsens outcomes in elderly patients with heart failure: An analysis of 48,117 patients in a community setting

Abstract

Aims: To assess the relationship between depression and clinical outcomes among elderly patients with heart failure (HF) in a community setting. Methods and results: To identify patients with HF and depression we used record linkage analysis of hospital discharge records, prescription databases and vital statistics. All consecutive patients aged ≥ 60 years in 6 Local Health Authorities in Italy were included. HF was defined as either: 1) hospital discharge with HF diagnosis (ICD-9: 428) and/or 2) chronic treatment for HF identified as concomitant (within 45 days) prescription of any combination of ACE inhibitors, digoxin, furosemide, bisoprolol, carvedilol, spironolactone, ARB-blockers. Depression was identified from exposure to psychotropic drugs before HF diagnosis. Cox proportional hazards models adjusted for major confounders were used. To adjust for potential residual known confounders, a propensity score analysis was performed. Sensitivity and subgroup analysis were used to demonstrate the consistency or robustness of the results.48,117 patients with HF were identified. Of these, 3328 (6.9%) were treated for depression. Among patients with HF, those with depression were significantly older, and more likely to be women with a previous stroke. Depression significantly worsened major outcomes including all cause mortality [HR (95%CI); 1.20 (1.08-1.33)] and the composite of stroke/TIA/AMI [1.23 (1.13-1.34)]. Patients with depression had no increased risk of rehospitalisation for HF. Propensity scores and subgroup analysis confirmed these findings. Conclusion: Among elderly patients with HF, depression was independently associated with poor clinical outcomes mostly due to an increase in vascular events.

High mortality among heart failure patients treated with antidepressants

“…In the present study, 7.2% of the heart failure patients received an antidepressant. Similar results were found in a large community cohort of elderly patients with SHF [10]. In other studies, it has been found that 28 to 48% of SHF patients in an out-patient clinic experience depression when depression is defined by the questionnaire [11,12].…”

Management of bleeding in acquired hemophilia A: results from the European Acquired Haemophilia (EACH2) Registry

“…PS methodology is a useful tool to reduce selection bias in observational studies 15,16 and has already been used in many therapeutic fields. [33][34][35][36] Treatment comparisons in such contexts are still prone to residual bias, which PS methods cannot take into account, however; and although sensitivity analysis can overcome residual bias by addressing its extent, these attempts to assess treatment effectiveness should be considered exploratory in nature.…”

Research Priorities in Geriatric Palliative Care: Nonpain Symptoms

“…Depression increased all-cause mortality by 20% in elderly patients with HF; 49 anxiety disorders are present in up to 40% of PD patients, substantially adversely affecting quality of life. 50 Mood disorders are frequently underrecognized and undertreated in these populations, due in part to lack of adequate assessment tools, differences in presentations of mood disorders in these populations, and a failure of primary treating physicians to evaluate psychiatric issues.…”

“…Changes in aging physiology may alter perception, characteristic, and intensity of nonpain symptoms. 49 Understanding the relationship between aging physiology and symptom perception will inform effective symptom assessment and treatment.…”