Depressive symptoms and outcomes in patients with heart failure: data from the COACH study
1 Department of Cardiology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
2 Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
3 College of Nursing, University of Kentucky, Lexington, KY, USA
4 Health Psychology Section, Department of Health Science, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
* Corresponding author. Tel: +31 50 3614889, Fax: +31 50 3611731, Email: g.a.t.lesman-leegte{at}thorax.umcg.nl
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Abstract |
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Aims: To study the prognostic value of depressive symptoms on heart failure (HF) readmission and mortality, in a large and clinically relevant population of hospitalized HF patients adjusted for disease severity by B-type natriuretic peptide (BNP) level.
Methods and results: We studied 958 patients enrolled after hospitalization for HF; 37% female; mean age 71 ± 11 years; New York Heart Association class II (51%) or III/IV (49%). Left ventricular ejection fraction: 33% ± 14%, and median BNP level: 454 pg/mL (75% CI, 195–876 pg/mL). In total, 377 patients (39%) had depressive symptoms [Centre for Epidemiological Studies Depression Scale (CES-D) score 
16] and 200 (21%) had severe depressive symptoms (score 24). During 18 months of follow-up, 386 (40%) patients reached the primary endpoint of death or readmission for HF. In multivariate analyses, CES-D was significantly associated with the primary endpoint [hazard ratio (HR) 1.13, P = 0.02], and also with both individual components of the primary endpoint [HF readmission (HR 1.165, P = 0.02) and mortality (HR 1.169, P = 0.02)]. Patients with severe depressive symptoms had a >40% higher risk for HF readmission or death.
Conclusion: In patients with HF, depression is independently associated with poor outcomes. These findings highlight the need for continued exploration of whether improvements in depression lead to better cardiovascular outcomes.
The study was registered at clinical trial (www.trialregister.nl): NCT 98675639.
Key Words: Depressive symptoms • Heart failure • Prognosis • Readmission • B-type natriuretic peptide
Received May 18, 2009; Revised September 9, 2009; Accepted September 21, 2009
The main results of the COACH study were presented at The Late Breaking Clinical Trial Sessions of the American College of Cardiology, New Orleans, LA, USA, 2007.
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