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J Am Coll Cardiol, 2003; 42:1811-1817, doi:10.1016/j.jacc.2003.07.013
© 2003 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: EFFECT OF DEPRESSION/ANXIETY ON CARDIAC EVENTS

Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure

John S. Rumsfeld, MD, PhD, FACC*,*, Edward Havranek, MD, FACC{dagger}, Frederick A. Masoudi, MD, MSPH, FACC{dagger}, Eric D. Peterson, MD, MPH, FACC{ddagger}, Philip Jones, MS§, Joseph F. Tooley, PharmD||, Harlan M. Krumholz, MD, FACC, John A. Spertus, MD, MPH, FACC§ Cardiovascular Outcomes Research Consortium (CORC)

* Denver VA Medical Center, Denver, ColoradoUSA
{dagger} Denver Health Medical Center, Denver, Colorado, USA
{ddagger} Duke University Medical Center, Durham, North Carolina, USA
§ Mid-America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
|| Pharmacia Corporation, Skokie, Illinois, USA
Yale University Medical Center, New Haven, Connecticut, USA

* Reprint requests and correspondence: Dr. John S. Rumsfeld, Cardiology (111B), Denver VA Medical Center, 1055 Clermont Street, Denver, Colorado 80220, USA.
John.Rumsfeld{at}med.va.gov
John.Rumsfeld{at}uchsc.edu

OBJECTIVES: The purpose of this study was to assess whether depressive symptoms are independently associated with changes in heart failure (HF)-specific health status.

BACKGROUND: Depression is common in patients with HF, but the impact of depressive symptoms on the health status of these patients over time is unknown.

METHODS: We conducted a multicenter prospective cohort study of outpatients with HF. Data from 460 patients who completed a baseline Medical Outcomes Study-Depression Questionnaire and both a baseline and follow-up (6 ± 2 weeks) Kansas City Cardiomyopathy Questionnaire (KCCQ) were analyzed. The KCCQ measures HF-specific health status, including symptoms, physical and social function, and quality of life. Multivariable regression was used to evaluate depressive symptoms as a predictor of change in KCCQ scores, adjusting for baseline KCCQ scores and other patient variables. The primary outcome was change in KCCQ summary scores (range 0 to 100; higher scores indicate better health status; 5 points is a clinically meaningful change).

RESULTS: Approximately 30% (139/460) of the patients had significant depressive symptoms at baseline. Depressed patients had markedly lower baseline KCCQ summary scores (ß = –19.6; p < 0.001). After adjustment for potential confounders, depressed patients were at risk for significant worsening of their HF symptoms, physical and social function, and quality of life (average change in KCCQ summary score = –7.1 points; p < 0.001). Depressive symptoms were the strongest predictor of decline in health status in the multivariable models.

CONCLUSIONS: Depressive symptoms are a strong predictor of short-term worsening of HF-specific health status. The recognition and treatment of depression may be an important component of HF care.

Abbreviations and Acronyms
  CI = confidence interval
  HF = heart failure
  KCCQ = Kansas City Cardiomyopathy Questionnaire
  MOS-D = Medical Outcomes Study-Depression Questionnaire
  OR = odds ratio




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