Role of depressive symptoms in the prognosis of heart failure and its potential clinical predictors

Abstract

AimsThis study aims to analyse the factors associated with prognosis in hospitalized patients with heart failure, particularly the role of depressive symptoms, and to develop a prediction model for depressive symptoms based on clinical characteristics in hospitalized patients with heart failure. Methods and results Baseline information was collected at admission, and patients were followed up after discharge. The endpoint events were being hospitalized for heart failure or all-cause death. Depressive symptoms were evaluated and defined via the Patient Health Questionnaire (PHQ)-2 and PHQ-9. The bidirectional elimination was used to screen independent predictors of heart failure with depression symptoms. The least absolute shrinkage and selection operator (LASSO) optimized the predictor variables, and the prediction model was constructed. The model was internally validated by the bootstrap sampling method (Bootstrap), and its performance was assessed by discrimination and calibration. The mean age of patients with heart failure was 69.43 ± 12.15 years, and the proportion of males was 66.67%. The prevalence of depressive symptoms in hospitalized patients with heart failure was 46.83%, and the prevalence of moderate/severe depressive symptoms was 11.62%. Eighty cases (30.30%) were readmitted for heart failure, and 13 cases (4.92%) were all-cause deaths. Depressive symptoms (HR = 2.43, 95% CI: 1.55-3.80) and the PHQ-9 score (HR = 1.11, 95% CI: 1.06-1.16) were both independent risk factors for endpoint events (P < 0.001). For heart failure patients combined with depressive symptoms, obesity (OR = 0.27, 95% CI: 0.09-0.77, P = 0.015), N-terminal brain natriuretic peptide precursor (NT-proBNP) level (lnNT-proBNP: OR = 1.55, 95% CI: 1.20-2.01, P < 0.001) and red blood cell distribution width (RDW) (OR = 1.26, 95% CI: 1.08-1.47, P = 0.004) were the independent factors. Six variables, including cardiovascular disease hospitalization history, obesity, renal insufficiency, NT-proBNP level, neutrophil ratio and RDW, were included to construct the prediction model. The area under the curve (AUC) was 0.730 in the original data, and the calibration curve was approximately distributed along the reference line in Bootstrap (500 resamplings), indicating the high level of discrimination and calibration of this model. Conclusions Depressive symptoms and the PHQ-9 score are both independent risk factors for the prognosis of hospitalized patients with heart failure. In hospitalized patients with heart failure, the risk prediction model developed in this study has good predictive power for depressive symptoms.

Low body mass index and disease duration as factors associated with depressive symptoms of Chinese inpatients with chronic heart failure

“…Our outcome was in line with Yang (et al’s, 2021) results that low BMI ( β = −0.116, p = 0.049) was a risk factor for depressive symptoms in patients with CHF, and consistent with a recent study (Duan et al, 2022) that obesity (OR = 0.27, CI = 0.09–0.77, p = 0.015) was independently related to depressive symptoms in hospitalized patients with HF. The possible reasons why low BMI may lead to depressive symptoms in patients with CHF are as follows: previous studies (Qing et al, 2021) showed that patients with CHF accompanied by loss of appetite had a higher risk of depression.…”

A bibliometric analysis of research on heart failure comorbid with depression from 2002 to 2021

“…Secondly, screening for depression in HF with traditional questionnaires is complex and challenging due to the overlap of HF symptoms and risk factors for depression, so the objective indicators for assessing depressive symptoms in hospitalized patients with HF are necessary. A study showed that the risk of depression in hospitalized HF patients can be identified by a predictive model consisting of six predictor variables, including history of CVD hospitalization, obesity, renal insufficiency, NT-proBNP (lnNT-proBNP), N (%), and RDW [ 37 ]. Thirdly, the current treatment of depression in HF patients is not fully effective.…”

The Role of Brain-Derived Neurotrophic Factor (BDNF) in Depression and Cardiovascular Disease: A Systematic Review

“…Several clinical studies have already demonstrated a poor medical prognosis for patients suffering from both conditions [45,46]. A kind of dose-response relationship has been proposed between the severity of depression and cardiac prognosis in depressed patients [47,48], and conversely, an increase in depressive symptoms has been observed in patients with CVD [46,49]. Investigating the biological mechanisms underlining this bidirectional relationship, some animal and human studies have hypothesised that BDNF might play a mediating role in the onset of one of these two diseases because lower serum BDNF levels were observed in patients of both CVD and depression [50][51][52][53].…”