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Meta-Analysis
. 2017 Mar:94:82-89.
doi: 10.1016/j.jpsychores.2017.01.010. Epub 2017 Jan 24.

Depression increases the risk of mortality in patients with heart failure: A meta-analysis

Emily C Gathright  1 , Carly M Goldstein  2 , Richard A Josephson  3 , Joel W Hughes  4
Affiliations
Meta-Analysis

Depression increases the risk of mortality in patients with heart failure: A meta-analysis

Emily C Gathright et al. J Psychosom Res. 2017 Mar.

Abstract

Background: Depression is a risk factor for mortality in cardiovascular diseases. Prior studies confirm that depression predicts adverse outcomes in patients with heart failure (HF). However, data were inconclusive regarding the effect of depression on mortality. This meta-analysis examines the relationship between depression and mortality in HF.

Methods: Prospective studies of depression and mortality in HF published between 1999 and April 2016 were located using PubMed, PsychINFO, and MEDLINE. Comprehensive Meta-Analysis software was used to compute an aggregated effect size estimates of hazard ratios and to conduct subgroup analyses.

Results: Eighteen studies met inclusion criteria. For 8 aggregated univariate and 14 multivariate estimates, depressive symptoms were related to all-cause mortality. A pooled HR of 3 multivariate analyses indicated that depressive symptoms were not linked to cardiovascular mortality. In subgroup analyses, depression predicted all-cause mortality in samples with a mean age >65. The impact of depression on all-cause mortality also differed by follow-up duration, with samples with shorter follow-up durations demonstrating a larger effect.

Conclusions: In HF, depression is related to increased all-cause mortality risk, with stronger effects in samples with shorter follow-up and in older adults. In older adults, depression may serve as a marker of more severe HF. However, this possibility is difficult to examine given inconsistent adjustment for HF severity. Additional studies may assist in determining the relationship between depression and cardiovascular mortality, as the low number of studies examining cardiovascular mortality may have precluded detection of an effect.

Keywords: Depression; Heart failure; Meta-analysis; Mortality.

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Conflict of interest statement

Conflict of Interest: The authors have no competing interests to report.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Forest plot of the univariate association between depression and all-cause mortality in HF.
Figure 3
Figure 3
Forest plot of the multivariate association between depression and all-cause mortality in HF.
Figure 4
Figure 4
Forest plot of association between depression and cardiovascular mortality in HF.
See this image and copyright information in PMC

References

    1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28. - PMC - PubMed
    1. Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, et al. Forecasting the Impact of Heart Failure in the United States A Policy Statement From the American Heart Association. Circulation: Heart Failure. 2013;6(3):606–19. - PMC - PubMed
    1. McMurray J, Stewart S. The burden of heart failure. European Heart Journal Supplements. 2002;4(suppl D):D50–D8.
    1. Levy D, Kenchaiah S, Larson MG, Benhamin EJ, Kupka MJ, Ho KKL, et al. Long-term trends in the incidence of and survival with heart failure. The New England Journal of Medicine. 2002;347:1397–402. - PubMed
    1. Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP, et al. Trends in heart failure and survival in a community-based population. Journal of the American Medical Association. 2004;292:344–50. - PubMed

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