Disclosures: The authors report no relevant financial disclosures.
December 22, 2021
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Severe depression predicts more all-cause hospital readmissions in patients with HF

Disclosures: The authors report no relevant financial disclosures.
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Patients with HF who had severe depression were more likely to have multiple all-cause hospital readmissions compared with patients without depression, according to a prospective cohort study in The American Journal of Cardiology.

Kenneth E. Freedland

“Most studies of hospital readmissions of patients with HF have focused on 30-day readmissions, as have most efforts to reduce readmissions,” Kenneth E. Freedland, PhD, professor of psychiatry at Washington University of St. Louis, and colleagues wrote. “However, many patients are readmitted multiple times over longer intervals. Risk factors such as depression that can persist throughout HF may increase the rate of readmissions over periods that extend far beyond the first 30 days after hospitalization.”

depressed person sitting on a bench
Source: Adobe Stock

The researchers analyzed 400 adults with HF who were screened for eligibility from July 2014 to December 2016, at Barnes-Jewish Hospital in St. Louis, 277 of whom completed 24 months of follow-up. Freedland and colleagues used the Patient Health Questionnaire-9 (PHQ-9) to assess depression at baseline and every 3 months after; a score of 0 to 9 indicated no depression, 10 to 14 indicated mild depression and 15 to 27 indicated severe depression.

Among the cohort, 21% were mildly depressed and 22% were severely depressed at baseline, the researchers wrote.

More severe depression was associated with younger age, higher NYHA class, chronic obstructive pulmonary disease (COPD), absence of atrial fibrillation, use of antidepressants and history of major depression, according to the researchers.

During follow-up, there were 841 readmissions among 227 patients without depression, 321 among 85 patients with mild depression and 419 among 88 patients with severe depression.

A higher rate of multiple all-cause readmissions was associated with higher PHQ-9 scores (adjusted HR = 1.02; 95% CI, 1-1.04; P = .03), younger age (P = .0003), higher NYHA class (aHR = 1.35; 95% CI, 1.14-1.6; P = .0007), diabetes (aHR = 1.51; 95% CI, 1.14-2; P = .004), COPD (aHR = 1.49; 95% CI, 1.14-1.96; P = .004), hypertension (aHR = 1.77; 95% CI, 1.2-2.61; P = .004) and lower estimated glomerular filtration rate (P = .002).

Assuming a Poisson process for readmission rates, the researchers determined patients with severe depression had higher odds of readmission compared with those without depression (P = .0003), with an insignificant difference between the two when assuming a Poisson process with overdispersion (P = .07).

There was no difference in readmission rates between patients with mild depression and no depression, and more readmissions did not predict more severe depression, the researchers found.

Freedland and colleagues reported limitations, including dependence on electronic medical records for data, some missing echocardiography data at index hospitalization, relatively small study population and use of a patient population from a large, urban teaching hospital.

“Recognition and treatment of depression may improve quality of life and reduce the rate of multiple readmissions in patients with HF,” they wrote.