CLINICAL STUDY
Depressive symptoms and risk of functional decline and death in patients with heart failure
Viola Vaccarino, MD, PhD*,
Stanislav V. Kasl, PhD*,
Jerome Abramson, PhD* and
Harlan M. Krumholz, MD, FACC*   
* Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, Georgia, USA
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
Department of Medicine (Cardiology), Yale University School of Medicine, New Haven, Connecticut, USA
Manuscript received November 1, 2000;
revised manuscript received March 15, 2001,
accepted March 26, 2001.
Reprint requests and correspondence: Dr. Viola Vaccarino, Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1256 Briarcliff Road, Suite 1 North, Atlanta, Georgia 30306
lvaccar{at}ecor.cardio.emory.edu
OBJECTIVES
We sought to examine whether depressive symptoms are associated with poorer prognosis in patients with heart failure.
BACKGROUND
Depression is an established risk factor for poor outcome in patients with coronary heart disease (CHD). Little is known of its role in patients with heart failure.
METHODS
We prospectively followed 391 patients  50 years of age who met criteria for decompensated heart failure on hospital admission. The outcome of the study was death or decline in activities of daily living (ADL) at six months, relative to baseline. Depressive symptoms were measured at baseline by means of the Geriatric Depression Scale, Short-Form, with 6 to 7 symptoms, 8 to 10 symptoms and 11 symptoms indicating mild, moderate and severe levels of depressive symptoms, respectively.
RESULTS
There was a strong and graded association between the severity of depressive symptoms at baseline and the rate of the combined end point of either functional decline or death at six months. After adjustment for demographic factors, medical history, baseline functional status and clinical severity, patients with 11 depressive symptoms, compared with those with <6 depressive symptoms, had an 82% higher risk of either functional decline or death, whereas the intermediate levels of depressive symptoms showed intermediate risk (p = 0.003 for trend). A similar graded association was found for functional decline and death separately; however, after multivariate analysis, the association with mortality was less strong and no longer statistically significant.
CONCLUSIONS
An increasing number of depressive symptoms is a negative prognostic factor for patients with heart failure, just as it is for patients with CHD.
|
Abbreviations and Acronyms
| | ADL | = activities of daily living | | CHD | = coronary heart disease | | GDS | = Geriatric Depression Scale | | LVEF | = left ventricular ejection fraction |
|
This article has been cited by other articles:
|
|
|
|
 
S. A. Everson-Rose, T. T. Lewis, K. Karavolos, S. A. Dugan, D. Wesley, and L. H. Powell
Depressive Symptoms and Increased Visceral Fat in Middle-Aged Women
Psychosom Med,
May 1, 2009;
71(4):
410 - 416.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. S. Rathore, Y. Wang, B. G. Druss, F. A. Masoudi, and H. M. Krumholz
Mental Disorders, Quality of Care, and Outcomes Among Older Patients Hospitalized With Heart Failure: An Analysis of the National Heart Failure Project
Arch Gen Psychiatry,
December 1, 2008;
65(12):
1402 - 1408.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Whooley, P. de Jonge, E. Vittinghoff, C. Otte, R. Moos, R. M. Carney, S. Ali, S. Dowray, B. Na, M. D. Feldman, et al.
Depressive Symptoms, Health Behaviors, and Risk of Cardiovascular Events in Patients With Coronary Heart Disease
JAMA,
November 26, 2008;
300(20):
2379 - 2388.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Macchia, S. Monte, F. Pellegrini, M. Romero, A. D'Ettorre, L. Tavazzi, G. Tognoni, and A. P. Maggioni
Depression worsens outcomes in elderly patients with heart failure: An analysis of 48,117 patients in a community setting
Eur J Heart Fail,
July 1, 2008;
10(7):
714 - 721.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Friedman, J. M. Lyness, R. L. Delavan, Chunyu Li, and W. H. Barker
Major Depression and Disability in Older Primary Care Patients With Heart Failure
J Geriatr Psychiatry Neurol,
June 1, 2008;
21(2):
111 - 122.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J T Parissis, M Nikolaou, D Farmakis, V Bistola, I A Paraskevaidis, S Adamopoulos, G Filippatos, and D T Kremastinos
Clinical and prognostic implications of self-rating depression scales and plasma B-type natriuretic peptide in hospitalised patients with chronic heart failure
Heart,
May 1, 2008;
94(5):
585 - 589.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. A. Thomas, D. W. Chapa, E. Friedmann, C. Durden, A. Ross, M. C. Y. Lee, and H.-J. Lee
Depression in Patients With Heart Failure: Prevalence, Pathophysiological Mechanisms, and Treatment
Crit. Care Nurse,
April 1, 2008;
28(2):
40 - 55.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Strain and M. Blumenfield
Challenges for Consultation-Liaison Psychiatry in the 21st Century
Psychosomatics,
April 1, 2008;
49(2):
93 - 96.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Azevedo, P. Bettencourt, F. Frioes, M. Alvelos, C. Abreu-Lima, H.-W. Hense, and H. Barros
Depressive Symptoms and Heart Failure Stages
Psychosomatics,
February 1, 2008;
49(1):
42 - 48.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Faller, S. Stork, M. Schowalter, T. Steinbuchel, V. Wollner, G. Ertl, and C. E. Angermann
Depression and survival in chronic heart failure: Does gender play a role?
Eur J Heart Fail,
October 1, 2007;
9(10):
1018 - 1023.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. Andrei, R. Fraguas Jr., R. M.S. Telles, T. C.T.F. Alves, C. M.C. Strunz, A. Nussbacher, J. Rays, D. V. Iosifescu, and M. Wajngarten
Major Depressive Disorder and Inflammatory Markers in Elderly Patients With Heart Failure
Psychosomatics,
August 1, 2007;
48(4):
319 - 324.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Sherwood, J. A. Blumenthal, R. Trivedi, K. S. Johnson, C. M. O'Connor, K. F. Adams Jr, C. S. Dupree, R. A. Waugh, D. R. Bensimhon, L. Gaulden, et al.
Relationship of Depression to Death or Hospitalization in Patients With Heart Failure
Arch Intern Med,
February 26, 2007;
167(4):
367 - 373.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. M. Klein, C. L. Turvey, and C. J. Pies
Relationship of Coping Styles With Quality of Life and Depressive Symptoms in Older Heart Failure Patients
J Aging Health,
February 1, 2007;
19(1):
22 - 38.
[Abstract]
[PDF]
|
|
|
|
|
|
|
L. C. Barry, J. H. Lichtman, J. A. Spertus, J. S. Rumsfeld, V. Vaccarino, P. G. Jones, M. E. Plomondon, S. Parashar, and H. M. Krumholz
Patient Satisfaction With Treatment After Acute Myocardial Infarction: Role of Psychosocial Factors
Psychosom Med,
February 1, 2007;
69(2):
115 - 123.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. S. Redwine, P. J. Mills, S. Hong, T. Rutledge, V. Reis, A. Maisel, and M. R. Irwin
Cardiac-related Hospitalization and/or Death Associated With Immune Dysregulation and Symptoms of Depression in Heart Failure Patients
Psychosom Med,
January 1, 2007;
69(1):
23 - 29.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. O. Adewuya, B. A. Ola, O. E. Ajayi, A. O. Oyedeji, M. O. Balogun, and S. K. Mosaku
Prevalence and Correlates of Major Depressive Disorder in Nigerian Outpatients With Heart Failure
Psychosomatics,
December 1, 2006;
47(6):
479 - 485.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Rutledge, V. A. Reis, S. E. Linke, B. H. Greenberg, and P. J. Mills
Depression in Heart Failure: A Meta-Analytic Review of Prevalence, Intervention Effects, and Associations With Clinical Outcomes
J. Am. Coll. Cardiol.,
October 17, 2006;
48(8):
1527 - 1537.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Lesman-Leegte, T. Jaarsma, R. Sanderman, G. Linssen, and D. J. van Veldhuisen
Depressive symptoms are prominent among elderly hospitalised heart failure patients
Eur J Heart Fail,
October 1, 2006;
8(6):
634 - 640.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. G. Koenig, J. Vandermeer, A. Chambers, L. Burr-Crutchfield, and J. L. Johnson
Comparison of Major and Minor Depression in Older Medical Inpatients With Chronic Heart and Pulmonary Disease
Psychosomatics,
August 1, 2006;
47(4):
296 - 303.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Whooley
Depression and cardiovascular disease: healing the broken-hearted.
JAMA,
June 28, 2006;
295(24):
2874 - 2881.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. G. Koenig
Depression outcome in inpatients with congestive heart failure.
Arch Intern Med,
May 8, 2006;
166(9):
991 - 996.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. M. Hilton, G. Parker, S. McDonald, G. A. Heruc, A. Olley, H. Brotchie, C. Friend, and W. F. Walsh
A Validation Study of Two Brief Measures of Depression in the Cardiac Population: The DMI-10 and DMI-18.
Psychosomatics,
March 1, 2006;
47(2):
129 - 135.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. A. Everson-Rose, K. A. Skarupski, J. L. Bienias, R. S. Wilson, D. A. Evans, and C. F. M. de Leon
Do Depressive Symptoms Predict Declines in Physical Performance in an Elderly, Biracial Population?
Psychosom Med,
July 1, 2005;
67(4):
609 - 615.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. W. Gold, M.-L. Wong, D. S. Goldstein, H. K. Gold, D. S. Ronsaville, M. Esler, S. Alesci, A. Masood, J. Licinio, T. D. Geracioti Jr., et al.
Cardiac implications of increased arterial entry and reversible 24-h central and peripheral norepinephrine levels in melancholia
PNAS,
June 7, 2005;
102(23):
8303 - 8308.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Skobel, C. Norra, A. Sinha, C. Breuer, P. Hanrath, and C. Stellbrink
Impact of sleep-related breathing disorders on health-related quality of life in patients with chronic heart failure
Eur J Heart Fail,
June 1, 2005;
7(4):
505 - 511.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Pihl, A. Jacobsson, B. Fridlund, A. Stromberg, and J. Matensson
Depression and health-related quality of life in elderly patients suffering from heart failure and their spouses: a comparative study
Eur J Heart Fail,
June 1, 2005;
7(4):
583 - 589.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. P. Davis, N. M. Albert, and J. B. Young
Palliation of heart failure
American Journal of Hospice and Palliative Medicine,
May 1, 2005;
22(3):
211 - 222.
[Abstract]
[PDF]
|
|
|
|
|
|
|
N. Frasure-Smith and F. Lesperance
Reflections on Depression as a Cardiac Risk Factor
Psychosom Med,
May 1, 2005;
67(Supplement_1):
S19 - S25.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Junger, D. Schellberg, T. Muller-Tasch, G. Raupp, C. Zugck, A. Haunstetter, S. Zipfel, W. Herzog, and M. Haass
Depression increasingly predicts mortality in the course of congestive heart failure
Eur J Heart Fail,
March 2, 2005;
7(2):
261 - 267.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Mallik, H. M. Krumholz, Z. Q. Lin, S. V. Kasl, J. A. Mattera, S. A. Roumains, and V. Vaccarino
Patients With Depressive Symptoms Have Lower Health Status Benefits After Coronary Artery Bypass Surgery
Circulation,
January 25, 2005;
111(3):
271 - 277.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Marzari, S. Maggi, E. Manzato, C. Destro, M. Noale, D. Bianchi, N. Minicuci, G. Farchi, M. Baldereschi, A. Di Carlo, et al.
Depressive Symptoms and Development of Coronary Heart Disease Events: The Italian Longitudinal Study on Aging
J. Gerontol. A Biol. Sci. Med. Sci.,
January 1, 2005;
60(1):
85 - 92.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. P. Havranek, J. A. Spertus, F. A. Masoudi, P. G. Jones, and J. S. Rumsfeld
Predictors of the onset of depressive symptoms in patients with heart failure
J. Am. Coll. Cardiol.,
December 21, 2004;
44(12):
2333 - 2338.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. A. Everson-Rose, J. S. House, and R. P. Mero
Depressive Symptoms and Mortality Risk in a National Sample: Confounding Effects of Health Status
Psychosom Med,
November 1, 2004;
66(6):
823 - 830.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. S. Gottlieb, M. Khatta, E. Friedmann, L. Einbinder, S. Katzen, B. Baker, J. Marshall, S. Minshall, S. Robinson, M. L. Fisher, et al.
The influence of age, gender, and race on the prevalence of depression in heart failure patients
J. Am. Coll. Cardiol.,
May 5, 2004;
43(9):
1542 - 1549.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. O'Connor and K. E. Joynt
Depression: are we ignoring an important comorbidity in heart failure?
J. Am. Coll. Cardiol.,
May 5, 2004;
43(9):
1550 - 1552.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. Rumsfeld, E. Havranek, F. A. Masoudi, E. D. Peterson, P. Jones, J. F. Tooley, H. M. Krumholz, J. A. Spertus, and Cardiovascular Outcomes Research Consortium (CORC)
Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure
J. Am. Coll. Cardiol.,
November 19, 2003;
42(10):
1811 - 1817.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A.H. Stewart, F. M. North, T. M. West, K. J. Sharples, R.J. Simes, D. M. Colquhoun, H. D. White, A. M. Tonkin, and for the Long-Term Intervention With Pravastatin in
Depression and cardiovascular morbidity and mortality: cause or consequence?
Eur. Heart J.,
November 2, 2003;
24(22):
2027 - 2037.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. De Geest, L. Scheurweghs, I. Reynders, W. Pelemans, W. Droogne, J. Van Cleemput, M. Leventhal, and J. Vanhaecke
Differences in psychosocial and behavioral profiles between heart failure patients admitted to cardiology and geriatric wards
Eur J Heart Fail,
August 1, 2003;
5(4):
557 - 567.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. B. Keller
Past, Present, and Future Directions for Defining Optimal Treatment Outcome in Depression: Remission and Beyond
JAMA,
June 18, 2003;
289(23):
3152 - 3160.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Frasure-Smith and F. Lesperance
Depression and Other Psychological Risks Following Myocardial Infarction
Arch Gen Psychiatry,
June 1, 2003;
60(6):
627 - 636.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. L. Smith, F. A. Masoudi, V. Vaccarino, M. J. Radford, and H. M. Krumholz
Outcomes in heart failure patients with preserved ejection fraction: Mortality, readmission, and functional decline
J. Am. Coll. Cardiol.,
May 7, 2003;
41(9):
1510 - 1518.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Radzewitz, E. Miche, G. Herrmann, M. Nowak, U. Montanus, U. Adam, Y. Stockmann, and M. Barth
Exercise and muscle strength training and their effect on quality of life in patients with chronic heart failure
Eur J Heart Fail,
October 1, 2002;
4(5):
627 - 634.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. McMurray and M. A. Pfeffer
New Therapeutic Options in Congestive Heart Failure: Part I
Circulation,
April 30, 2002;
105(17):
2099 - 2106.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Jiang, V. Hasselblad, R. R. Krishnan, and C. M. O'Connor
Patients with CHF and depression have greater risk of mortality and morbidity than patients without depression
J. Am. Coll. Cardiol.,
March 6, 2002;
39(5):
919 - 920.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Vaccarino
Patients with CHF and depression have greater risk of mortality and morbidity than patients without depression: Reply
J. Am. Coll. Cardiol.,
March 6, 2002;
39(5):
920 - 921.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Rozzini, T. Sabatini, G. B. Frisoni, M. Trabucchi, W. Jiang, R. R. Krishnan, and C. M. O'Connor
Depression and Major Outcomes in Older Patients With Heart Failure
Arch Intern Med,
February 11, 2002;
162(3):
362 - 364.
[Full Text]
[PDF]
|
|
|
|
