© 2005 European Society of Cardiology
Depression increasingly predicts mortality in the course of congestive heart failure
a Department of General Internal and Psychosomatic Medicine, University of Heidelberg INF 410, D-69120 Heidelberg, Germany
b Department of Cardiology, University of Heidelberg Heidelberg, Germany
c Department of Cardiology, Theresienkrankenhaus Mannheim, Germany
* Corresponding author. Tel.: +49 6221 568657; fax: +49 6221 565749. E-mail address: Jana_Juenger{at}med.uni-heidelberg.de
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Abstract |
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Background: Congestive heart failure (CHF) is frequently associated with depression. However, the impact of depression on prognosis has not yet been sufficiently established.
Aims: To prospectively investigate the influence of depression on mortality in patients with CHF.
Methods: In 209 CHF patients depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D).
Results: Compared to survivors (n=164), non-survivors (n=45) were characterized by a higher New York Heart Association (NYHA) functional class (2.8±0.7 vs. 2.5±0.6), and a lower left ventricular ejection fraction (LVEF) (18±8 vs. 23±10%) and peakVO2 (13.1±4.5 vs. 15.4±5.2 ml/kg/min) at baseline. Furthermore, non-survivors had a higher depression score (7.5±4.0 vs. 6.1±4.3) (all P<0.05). After a mean follow-up of 24.8 months the depression score was identified as a significant indicator of mortality (P<0.01). In multivariate analysis the depression score predicted mortality independent from NYHA functional class, LVEF and peakVO2. Combination of depression score, LVEF and peakVO2 allowed for a better risk stratification than combination of LVEF and peakVO2 alone. The risk ratio for mortality in patients with an elevated depression score (i.e. above the median) rose over time to 8.2 after 30 months (CI 2.62–25.84).
Conclusions: The depression score predicts mortality independent of somatic parameters in CHF patients not treated for depression. Its prognostic power increases over time and should, thus, be accounted for in risk stratification and therapy.
Key Words: CHF, Congestive heart failure • LVEF, Left ventricular ejection fraction • NYHA, New York Heart Association • PeakVO2, peak oxygen uptake in cardiopulmonary exercise testing • HADS-D, Hospital Anxiety and Depression Scale in German
Received August 8, 2003; Revised May 5, 2004; Accepted May 24, 2004
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