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Worsening Depressive Symptoms Are Associated With Adverse Clinical Outcomes in Patients With Heart Failure
Open accessAbstract
Objectives The purpose of this study was to assess the impact of changes in symptoms of depression over a 1-year period on subsequent clinical outcomes in heart failure (HF) patients.Background Emerging evidence shows that clinical depression, which is prevalent among patients with HF, is associated with a poor prognosis. However, it is uncertain how changes in depression symptoms over time may relate to clinical outcomes.Methods One-hundred forty-seven HF outpatients with ejection fraction of less than 40% were assessed for depressive symptoms using the Beck Depression Inventory (BDI) at baseline and again 1 year later. Cox proportional hazards regression analyses, controlling for established risk factors, were used to evaluate how changes in depressive symptoms were related to a combined primary end point of death or cardiovascular hospitalization over a median follow-up period of 5 years (with a range of 4 to 7 years and no losses to follow-up).Results The 1-year change in symptoms of depression, as indicated by higher BDI scores over a 1-year interval (1-point BDI change hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.02 to 1.12, p = 0.007), was associated with death or cardiovascular hospitalization after controlling for baseline depression (baseline BDI HR: 1.1, 95% CI: 1.06 to 1.14, p < 0.001) and established risk factors, including HF cause, age, ejection fraction, plasma N-terminal pro-B-type natriuretic peptide level, and prior hospitalizations.Conclusions Worsening symptoms of depression are associated with a poorer prognosis in HF patients. Routine assessment of symptoms of depression in HF patients may help to guide appropriate medical management of these patients who are at increased risk for adverse clinical outcomes.
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“Worsening depression over a year is also a bad omen, hinting that regular monitoring could allow early intervention with the aim of improving outcomes. 100”
From Prioritizing symptom management in the treatment of chronic heart failure (2020) · cites this paper as [100]
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Cites
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MethodAssessment of Depression: The Depression Inventory
Beck, A. T., & Beamesderfer, A. (2015) · Modern problems of pharmacopsychiatry/Modern trends in pharmacopsychiatry · doi:10.1159/000395074 · Cited by 1,860 · cited 1×
“Depression—The Beck Depression Inventory (BDI) is a 21-item self-report measure of depressive symptomatology (14).”
BackgroundDepression and 18-Month Prognosis After Myocardial Infarction
Frasure‐Smith, N., Lespérance, F., & Talajic, M. R. (1995) · Circulation · doi:10.1161/01.cir.91.4.999 · Cited by 1,546 · cited 2×
“These studies also document that the cut point of a BDI score of 10 or greater is applicable in cardiac patient populations, where it has been associated with poorer prognosis (3,16,17).”
BackgroundLichtman, J. H., Bigger, J. T., Blumenthal, J. A., Frasure-Smith, N., Kaufmann, P. G., Lespérance, F., Mark, D. B., Sheps, D. S., Taylor, C. B., & Froelicher, E. S. (2008) · Circulation · doi:10.1161/circulationaha.108.190769 · Cited by 1,482
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“Studies from multiple investigative teams, including our own, have found that independent of HF disease severity, depressive symptoms are associated with adverse clinical outcomes for HF patients (3-8).”
BackgroundLespérance, F., Frasure‐Smith, N., Talajic, M. R., & Bourassa, M. G. (2002) · Circulation · doi:10.1161/hc0902.104707 · Cited by 722
Depressive symptoms and risk of functional decline and death in patients with heart failure
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“Studies from multiple investigative teams, including our own, have found that independent of HF disease severity, depressive symptoms are associated with adverse clinical outcomes for HF patients (3-8).”
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Relationship of Depression to Death or Hospitalization in Patients With Heart Failure
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“The study sample consisted of 47 patients, which represents 83% of the 177 patients who urvived 1 year after baseline assessments from our original tudy (3).”
BackgroundInfluentialChange in Depression as a Precursor of Cardiovascular Events
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“Our findings are consistent with observations in post-MI patients, in whom worsening symptoms of depression have been associated with greater risk of subsequent mortality (9-11).”
BackgroundResultCarney, R. M., Blumenthal, J. A., Freedland, K. E., Youngblood, M., Veith, R. C., Burg, M. M., Cornell, C., Saab, P. G., Kaufmann, P. G., Czajkowski, S. M., et al. (2004) · Psychosomatic Medicine · doi:10.1097/01.psy.0000133362.75075.a6 · Cited by 291 · cited 3×
“Our findings are consistent with observations in post-MI patients, in whom worsening symptoms of depression have been associated with greater risk of subsequent mortality (9-11).”
BackgroundResultSelf-citationDepression as a risk factor for mortality after acute myocardial infarction
Carney, R. M., Blumenthal, J. A., Catellier, D., Freedland, K. E., Berkman, L. F., Watkins, L. L., Czajkowski, S. M., Hayano, J., & Jaffe, A. S. (2003) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2003.08.007 · Cited by 249 · cited 2×
“These studies also document that the cut point of a BDI score of 10 or greater is applicable in cardiac patient populations, where it has been associated with poorer prognosis (3,16,17).”
BackgroundPredictors of the onset of depressive symptoms in patients with heart failure
Havranek, E. P., Spertus, J. A., Masoudi, F. A., Jones, P. G., & Rumsfeld, J. S. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.09.034 · Cited by 158 · cited 1×
“Although changes in depressive symptoms have been assessed previously in HF patients (12,13), their relationship to HF clinical outcomes has not been evaluated.”
BackgroundAntidepressant Use, Depression, and Survival in Patients With Heart Failure
O’Connor, C. M., Jiang, W., Kuchibhatla, M. N., Mehta, R. H., Clary, G. L., Cuffe, M. S., Christopher, E. J., Alexander, J. D., Califf, R. M., & Krishnan, R. R. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.20.2232 · Cited by 139 · cited 1×
“Moreover, elevated sympoms of depression measured by the BDI are associated with n increased risk of adverse events in cardiac patients, ncluding patients with HF (3,7,16,17).”
BackgroundPsychological Predictors of Prognosis in Chronic Heart Failure
Pelle, A. J. M., Gidron, Y., Szabó, B. M., & Denollet, J. (2008) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2008.01.004 · Cited by 107 · cited 1×
“Studies from multiple investigative teams, including our own, have found that independent of HF disease severity, depressive symptoms are associated with adverse clinical outcomes for HF patients (3-8).”
BackgroundJiang, W., O’Connor, C. M., Silva, S. G., Kuchibhatla, M. N., Cuffe, M. S., Callwood, D. D., Zakhary, B., Henke, E., Arias, R. M., & Krishnan, R. R. (2008) · American Heart Journal · doi:10.1016/j.ahj.2008.05.003 · Cited by 102 · cited 1×
“In a recently completed RCT in HF patients with depression (22), no antidepressant benefit of sertraline compared to placebo was observed, although remitting depression symptoms were found to be associated with improved health status and quality of life (23).”
BackgroundDepression and Congestive Heart Failure
Guck, T. P., Elsasser, G. N., Kavan, M., & J., E. J. E. (2003) · Congestive Heart Failure · doi:10.1111/j.1527-5299.2003.01356.x · Cited by 102 · cited 1×
“depression also is common in HF, with prevalence estimates ranging from 24-42% (2).”
BackgroundXiong, G. L., Jiang, W., Clare, R. M., Shaw, L. K., Smith, P. K., Mahaffey, K. W., O’Connor, C. M., Krishnan, K. R., & Newby, L. K. (2006) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2006.01.051 · Cited by 76
Murberg, T. A., & Furze, G. (2004) · PubMed · Cited by 67
Depression Outcome in Inpatients With Congestive Heart Failure
Koenig, H. G. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.9.991 · Cited by 53 · cited 1×
“Although changes in depressive symptoms have been assessed previously in HF patients (12,13), their relationship to HF clinical outcomes has not been evaluated.”
BackgroundFiuzat, M., Jiang, W., Spertus, J. A., Kuchibhatla, M. N., Cuffe, M. S., Krishnan, R. R., & O’Connor, C. M. (2009) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2009.06.069 · Cited by 1 · cited 1×
“In a recently completed RCT in HF patients with depression (22), no antidepressant benefit of sertraline compared to placebo was observed, although remitting depression symptoms were found to be associated with improved health status and quality of life (23).”
Background
Cited by
Sorted by citations
Forman, D. E., Arena, R., Boxer, R., Dolansky, M. A., Eng, J. J., Fleg, J. L., Haykowsky, M., Jahangir, A., Kaminsky, L. A., Kitzman, D. W., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000483 · Cited by 319
Blumenthal, J. A., Babyak, M. A., O’Connor, C., Keteyian, S., Landzberg, J., Howlett, J., Kraus, W., Gottlieb, S., Blackburn, G., Swank, A., et al. (2012) · JAMA · doi:10.1001/jama.2012.8720 · Cited by 305
“Diabetes 2322 261 (32) 117 (35) 378 (33) 255 (30) 115 (36) 370 (32)”
InfluentialGoldstein, C. M., Gathright, E. C., & Garcia, S. (2017) · Patient Preference and Adherence · doi:10.2147/ppa.s127277 · Cited by 138
“18 Major depression is associated with increased mortality 3 and 12 months following hospitalization for CVD 19 and 1 year after initial assessment in patients with HF. 20 However, despite decades of research, the scientific community does not fully understand the relationship between depression and mortality.”
InfluentialDepression and cardiovascular disease
Bradley, S. M., & Rumsfeld, J. S. (2015) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2015.02.002 · Cited by 143
“Depression is also associated with an increased risk of recurrent and fatal stroke among patients with prior stoke [12] and an increased risk of heart failure readmission and death among CHF patients [23–25].”
BackgroundTu, R., Zeng, Z., Zhong, G., Wu, W., Lu, Y., Bo, Z., He, Y., Huang, W.-Q., & Yao, L. (2014) · European Journal of Heart Failure · doi:10.1002/ejhf.101 · Cited by 132
Metadata
- Authors
- Sherwood, A., Blumenthal, J. A., Hinderliter, A. L., Koch, G. G., Adams, K. F., Dupree, C. S., Bensimhon, D. R., Johnson, K. S., Trivedi, R., Bowers, M., Christenson, R. H., & O'Connor, C. M.
- Affiliations
- Duke Medical Center (US)
- Duke University (US)
- University of North Carolina at Chapel Hill (US)
- Cardiovascular Research Foundation (US)
- University of Maryland, Baltimore (US)
- Corresponding author
- Sherwood, Andrew
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2011-01
- Volume
- 57
- Issue
- 4
- Pages
- 418-423
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC3622450
- OpenAlex
- W2029552522
- Cited by
- 122
- References
- 24
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 9 · 2023: 3 · 2022: 4 · 2021: 5 · 2020: 8 · 2019: 6 · 2018: 7 · 2017: 11 · 2016: 10 · 2015: 9 · 2014: 10 · 2013: 4 · 2012: 20
- FWCI
- 8.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute
- National Center for Research Resources
- National Institutes of Health (M01-RR-30)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- heart failure, depression, depressive symptoms, prognosis, mortality, cardiovascular hospitalization, Beck Depression Inventory, symptom change over time, ejection fraction, N-terminal pro-brain natriuretic peptide, depression screening
- MeSH terms
- Aged, Cardiac Output, Cause of Death, Depression, Female, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Outpatients, Predictive Value of Tests, Prognosis, Prospective Studies, Psychiatric Status Rating Scales, Regression Analysis, Severity of Illness Index, Cohort Studies, Incidence, Confidence Intervals, Odds Ratio, Survival Analysis, Hospital Mortality, Age Distribution, Sex Distribution, Sickness Impact Profile, Disease Progression, Risk Assessment
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