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Depression as an independent risk factor for all-cause mortality in heart failure patients.

Session Poster session 1 Saturday 08:30 -17:30

Speaker Ioanna Sokoreli

Event : Heart Failure 2015

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Comorbidities
  • Session type : Poster Session

Authors : I Sokoreli (Eindhoven,NL), G Geleijnse (Eindhoven,NL), S Pauws (Eindhoven,NL), J Riistama (Eindhoven,NL), A Tesanovic (Eindhoven,NL), G-J De Vries (Eindhoven,NL), A Crundall-Goode (Hull,GB), K Goode (Hull,GB), J Cleland (London,GB), A Clark (Hull,GB)

Authors:
I Sokoreli1 , G Geleijnse1 , S Pauws1 , J Riistama1 , A Tesanovic1 , G-J De Vries1 , A Crundall-Goode2 , K Goode2 , J Cleland3 , A Clark2 , 1Philips Research - Eindhoven - Netherlands , 2University of Hull - Hull - United Kingdom , 3Imperial College London - London - United Kingdom ,

Citation:
European Journal of Heart Failure Abstracts Supplement ( 2015 ) 17 ( Supplement 1 ), 69

Purpose: Depression is reported to be associated with mortality among patients with heart failure (HF). However, whether this reflects more severe disease or a greater co-morbidity or is independent of such risk factors is unclear.

Methods: OPERA-HF is an observational study enrolling patients hospitalized with heart failure. Inclusion criteria were: age > 18 years, hospitalized for or with HF and treated with loop diuretics and at least one of the following: left ventricular ejection fraction ≤ 40%, left atrial dimension > 4.0 cm or NT-ProBNP >400 pg/ml (if in sinus rhythm) or > 1200 pg/ml (if in atrial fibrillation)). Depression was assessed by Hospital Anxiety and Depression Scale (HADS-D) questionnaire. Co-morbidity was assessed by the Charlson Comorbidity Index (CCI). Kaplan-Meier and Cox regression analyses were used to estimate the association between depression and all-cause mortality.

Results: Of 154 patients that completed the HADS-D questionnaire, 103, 27 and 24 patients had no-to-normal (score 0-7), mild (score 8-10) or moderate-to-severe (score 11-21) depression, respectively. Over a mean follow-up time of 302 days, 27 out of 154 patients died. In univariate Cox regression analysis, moderate-to-severe depression was associated with an increased risk of death (HR: 5.11; 95% CI: 2.39 to 10.93; P < 0.001) comparing to no-to-normal or mild depression. Moderate-to-severe depression remained a significant predictor of mortality after controlling for sex, age, hypertension and NT-proBNP (HR: 6.50; 95% CI: 2.19 to 19.32; P < 0.001); and changed little with the further inclusion of the CCI in the model (HR: 5.38; 95% CI: 1.84 to 15.67; P < 0.005). On the other hand, a low HADS-D score between 0 and 7 was associated with a decreased mortality risk (HR: 0.21; 95% CI: 0.09 to 0.46; P < 0.001).

Conclusion: This analysis suggests that depression is strongly associated with an adverse outcome in the year after discharge from a HF hospital episode and that it may not be explained by the severity of HF or co-morbidity. Recognition and management of depression might improve outcome. Appropriately designed randomized trials are required.

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