Patients with HF who are diagnosed with depression have a fourfold greater risk for all-cause mortality and twofold greater risk for hospitalization and ED visits compared with patients who are not depressed.
For a prospective, cohort study, researchers from the Mayo Clinic in Rochester, Minn., studied 402 HF patients in three Minnesota Counties (58% men; mean age, 73 years). A nine-question survey revealed that 15% of patients had moderate to severe depression, 26% mild depression and 59% no evidence of depression.
During a mean follow-up of 1.6 years, the researchers recorded 781 hospitalizations, 1,000 ED visits, 15,515 outpatient visits and 74 deaths. Moderate to severe depression was associated with a twofold increased risk for hospitalization (HR=1.79; 95% CI, 1.3-2.47) and ED visits (HR=1.83; 95% CI, 1.34-2.5), increased risk for outpatient visits (RR=1.2; 95% CI, 1.00-1.45) and a fourfold increased risk for all-cause mortality (HR=4.06; 95% CI, 2.35-7.01).
Mild depression was associated with a marginal increase in hospitalizations (HR=1.16; 95% CI, 0.88-1.53) and ED visits (HR=1.35; 95% CI, 1.00-1.83) and outpatient visits (RR=1.04; 95% CI, 0.89-1.21), and a modest increased risk for mortality (HR=1.59; 95% CI, 0.89-2.83) compared with patients with more severe depression.
“Despite the high prevalence of depression in HF patients, of those reporting mild and moderate-severe depressive symptoms at study enrollment, only approximately one-third were on antidepressant medications at that time. Although it is possible that some patients were receiving a non-pharmacologic therapy, this finding raises the possibility that depression might be underrecognized and undertreated in these patients,” the researchers wrote.
“Further research is warranted to develop more effective clinical approaches for management of depression in heart failure patients,”Alanna M. Chamberlain, PhD, MPH, assistant professor of epidemiology at the Mayo Clinic in Rochester, Minn., said in a press release.
Disclosure: Chamberlain and colleagues report no relevant financial disclosures.