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J Am Coll Cardiol, 2004; 43:1542-1549, doi:10.1016/j.jacc.2003.10.064
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: HEART FAILURE

The influence of age, gender, and race on the prevalence of depression in heart failure patients

Stephen S. Gottlieb, MD, FACC*§,*, Meenakshi Khatta, RN, CRNP*, Erika Friedmann, PhD{ddagger}, Lynn Einbinder, MD*§, Scott Katzen, MD*§, Brian Baker, BA*§, Joanne Marshall, RN*§, Stacey Minshall, RN*§, Shawn Robinson, MD, FACC*§, Michael L. Fisher, MD, FACC*§, Matthew Potenza, BA*§, Brianne Sigler, BA*§, Carissa Baldwin, BA*§ and Sue Ann Thomas, RN, PhD, FAAN{dagger}

* Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
{dagger} University of Maryland School of Nursing, Baltimore, Maryland, USA
{ddagger} Brooklyn College, Brooklyn, New York, USA
§ Baltimore Veterans Administration Medical Center, Baltimore, Maryland, USA

Manuscript received September 11, 2003; revised manuscript received October 2, 2003, accepted October 21, 2003.

* Reprint requests and correspondence: Dr. Stephen S. Gottlieb, Division of Cardiology, University of Maryland Medical Systems, 22 South Greene Street, Baltimore, Maryland 21201, USA.
sgottlie{at}medicine.umaryland.edu

OBJECTIVES: The goal of this study was to determine the prevalence of depression in an out-patient heart failure (HF) population; its relationship to quality of life (QOL); and the impact of gender, race, and age.

BACKGROUND: Most studies of depression in HF have evaluated hospitalized patients (a small percentage of the population) and have ignored the influence of various patient characteristics. Although reported depression rates among hospitalized patients range from 13% to 77.5%, out-patient studies have been small, have reported rates of 13% to 42%, and have not adequately accounted for the impact of age, race, or gender.

METHODS: A total of 155 patients with stable New York Heart Association functional class II, III, and IV HF and an ejection fraction <40% were given questionnaires to assess QOL and depression. These included the Medical Outcomes Study Short Form, the Minnesota Living with Heart Failure questionnaire, and the Beck Depression Inventory (BDI). Depression was defined as a score on the BDI of ≥10.

RESULTS: A total of 48% of the patients scored as depressed. Depressed patients tended to be younger than non-depressed patients. Women were more likely (64%) to be depressed than men (44%). Among men, blacks (34%) tended to have less depression than whites (54%). Depressed patients scored significantly worse than non-depressed patients on all components of both the questionnaires measuring QOL. However, they did not differ in ejection fraction or treatment, except that depressed patients were significantly less likely to be receiving beta-blockers.

CONCLUSIONS: Depression is common in patients with HF, with age, gender, and race influencing its prevalence in ways similar to those observed in the general population. These data suggest that pharmacologic or non-pharmacologic treatment of depression might improve the QOL of HF patients.

Abbreviations and Acronyms
  BDI = Beck Depression Inventory
  CI = confidence interval
  HF = heart failure
  MI = myocardial infarction
  MLWHF = Minnesota Living With Heart Failure questionnaire
  NYHA = New York Heart Association
  OR = odds ratio
  QOL = quality of life
  SF-36 = Medical Outcomes Study Short Form




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