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European Journal of Heart Failure 2008 10(7):714-721; doi:10.1016/j.ejheart.2008.05.011
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© 2008 European Society of Cardiology

Depression worsens outcomes in elderly patients with heart failure: An analysis of 48,117 patients in a community setting

Alejandro Macchiaa, Simona Montea, Fabio Pellegrinia, Marilena Romeroa, Antonio D'Ettorrea, Luigi Tavazzib, Gianni Tognonia and Aldo P. Maggionic,*

a Consorzio Mario Negri Sud, Santa Maria Imbaro Chieti, Italy
b IRCCS Policlinico San Matteo Pavia, Italy
c Centro Studi ANMCO Firenze, Italy

* Corresponding author. ANMCO Research Center, Via A. La Marmora 34, 50121 Firenze, Italy. Tel.: +39 055 5001703; fax: +39 055 583400. E-mail addresses: maggioni{at}anmco.it, centrostudi{at}anmco.it (A.P. Maggioni).


  Abstract

Aims: To assess the relationship between depression and clinical outcomes among elderly patients with heart failure (HF) in a community setting.

Methods and results: To identify patients with HF and depression we used record linkage analysis of hospital discharge records, prescription databases and vital statistics. All consecutive patients aged ≥ 60 years in 6 Local Health Authorities in Italy were included. HF was defined as either: 1) hospital discharge with HF diagnosis (ICD-9: 428) and/or 2) chronic treatment for HF identified as concomitant (within 45days) prescription of any combination of ACE inhibitors, digoxin, furosemide, bisoprolol, carvedilol, spironolactone, ARB-blockers. Depression was identified from exposure to psychotropic drugs before HF diagnosis. Cox proportional hazards models adjusted for major confounders were used. To adjust for potential residual known confounders, a propensity score analysis was performed. Sensitivity and subgroup analysis were used to demonstrate the consistency or robustness of the results.

48,117 patients with HF were identified. Of these, 3328 (6.9%) were treated for depression. Among patients with HF, those with depression were significantly older, and more likely to be women with a previous stroke. Depression significantly worsened major outcomes including all cause mortality [HR (95%CI); 1.20 (1.08–1.33)] and the composite of stroke/TIA/AMI [1.23 (1.13–1.34)]. Patients with depression had no increased risk of rehospitalisation for HF. Propensity scores and subgroup analysis confirmed these findings.

Conclusion: Among elderly patients with HF, depression was independently associated with poor clinical outcomes mostly due to an increase in vascular events.

Key Words: Heart failure • Depression • Prognosis

Received November 29, 2007; Revised April 17, 2008; Accepted May 21, 2008


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