Comorbid Depression and Heart Failure: A Community Cohort Study

Abstract

Objective: To examine the association between depression and clinical outcomes in heart failure (HF) in a community cohort.

Patients and methods: HF patients in Minnesota, United States completed depression screening using the 9-item Patient Health Questionnaire (PHQ-9) between 1st Oct 2007 and 1st Dec 2011; patients with PHQ-9≥5 were labelled "depressed". We calculated the risk of death and first hospitalization within 2 years using Cox regression. Results were adjusted for 10 commonly used prognostic factors (age, sex, systolic blood pressure, estimated glomerular filtration rate, serum sodium, ejection fraction, blood urea nitrogen, brain natriuretic peptide, presence of diabetes and ischaemic aetiology). Area under the curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) compared depression as a predictor against the aforementioned factors.

Results: 425 patients (mean age 74, 57.6% males) were included in the study; 179 (42.1%) had PHQ-9≥5. The adjusted hazard ratio of death was 2.02 (95% CI 1.34-3.04) and of hospitalization was 1.42 (95% CI 1.13-1.80) for those with compared to those without depression. Adding depression to the models did not appreciably change the AUC but led to statistically significant improvements in both the IDI (p = 0.001 and p = 0.005 for death and hospitalization, respectively) and NRI (for death and hospitalization, 35% (p = 0.002) and 27% (p = 0.007) were reclassified correctly, respectively).

Conclusion: Depression is frequent among community patients with HF and associated with increased risk of hospitalizations and death. Risk prediction for death and hospitalizations in HF patients can be improved by considering depression.

Fig 1. Patient Recruitment.

PHQ-9 = 9-item Patient Health Questionnaire.

Fig 2

(A) Survival Plot for All-cause Mortality for Chronic Heart Failure Patients. (B) 1-Cumulative Incidence Plot for First Hospitalization Treating Death as a Competing Risk for Chronic Heart Failure Patients. Depressed Defined as 9-item Patient Health Questionnaire (PHQ-9) ≥5.