Mechanisms of the association between depressive symptoms and long-term mortality in heart failure
Received 17 September 2009; accepted 12 November 2009.
Background
The long-term prognostic influence of depression on patients hospitalized for heart failure (HF) is unknown. No previous study has examined systematically the mechanisms of the relationship between depression and mortality in HF.
Methods
Prospective study of 433 patients hospitalized for HF-related emergencies in 4 Spanish hospitals. Baseline depressive symptoms were assessed with the 10-item Geriatric Depression Scale (GDS). The association between depressive symptoms and mortality was summarized with hazard ratios (HRs) obtained from Cox regression, with sequential adjustment for possible mechanisms of the association.
Results
Of the 433 study participants, 103 (23.8%) had major depression (GDS-10 ≥5) at baseline. During a mean follow-up of 5.7 years, 305 deaths (70%) occurred. Compared with those who were not depressed, subjects with major depression showed higher mortality (age and sex-adjusted HR 1.52, 95% CI 1.15-2.01). Subsequent adjustment for comorbidity reduced the HR to 1.45 (95% CI 1.10-1.93). Additional adjustment for severity of cardiac lesion and for lifestyles, foremost physical inactivity, led to a HR of 1.27 (95% CI 0.95-1.70). After further adjustment for pharmacologic treatment of HF and particularly for disability in instrumental activities of daily living, the HR dropped almost to the null value (HR 1.10, 95% CI 0.82-1.49).
Conclusions
Depressive symptoms in patients hospitalized for HF are associated with higher long-term mortality; this association is largely explained by the frequent comorbidity, physical inactivity, and disability of these patients.
aDepartament of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, CIBERESP, Madrid, Spain
bDivision of Geriatrics, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
cService of Preventive Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
dDepartment of Preventive Medicine and Public Health, Universidad de Sevilla, Sevilla, Spain
eService of Internal Medicine I, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Reprint requests: Fernando Rodríguez Artalejo, MD, Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, sn, 28029 Madrid, Spain.
ABSTRACT