Depression worsens survival, outcomes in heart failure patients

Older heart failure patients with depression have a significantly greater risk of death, stroke or transient ischemic attack (TIA) and acute myocardial infarction (AMI) compared with those without depression, reported Aldo Maggioni, MD, during the American College of Cardiology's 56th annual scientific session.

"Depression is associated with 11% to 25% of chronic heart failure (CHF) cases," said Dr. Maggioni, ANMCO Research Center, Chieti, Italy. "While the impact of depression in coronary artery disease is clear, it has been less clear for CHF."

To evaluate the impact of depression on elderly CHF patients he analyzed two regional Italian hospital discharge records, prescription databases, and vital statistics and identified 18,623 patients from 2000 to 2003. Median age was 78.6 years; 59.3% were female. Of these, 2,405 (12.9%) had been treated for depression.

Patients with depression were significantly older (79.2 years vs. 78.5 years), were more likely female (69% vs. 57.9%) and more often had a history of peripheral vascular disease (3.5% vs. 2.6%) or stroke (2.4% vs. 1.1%). The depressed heart failure patients were also more likely to have chronic obstructive pulmonary disease or a history of malignancy.

After following the patients for 1 year, Dr. Maggioni found that the risk of all cause mortality was 47% among the depressed CHF patients compared with 12% for those who were not depressed. In addition, depression was associated with a 53% risk of the composite endpoint of stroke, TIA, and AMI compared with only a 20% risk among CHF patients without depression. Depression also increased the rate of all-cause rehospitalization (27% vs. 9%) but did not increase the risk of rehospitalization specifically for CHF.

"In patients over age 60 with CHF, depression is frequent and independently associated with poorer outcomes," Dr. Maggioni said. He emphasized that clinicians should improve their ability to recognize depressive symptoms in their CHF patients and refer patients for depression diagnosis and treatment. "Treatment for depression in heart failure is important and may help improve relevant outcomes," he said.