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CLINICAL RESEARCH: HEART FAILURE

Predictors of the onset of depressive symptoms in patients with heart failure

Edward P. Havranek, MD, FACC^*,,*, John A. Spertus, MD, MPH, FACC, Frederick A. Masoudi, MD, MSPH, FACC^*,, Philip G. Jones, MS and John S. Rumsfeld, MD, PhD, FACC^*,

^* University of Colorado Health Sciences Center
Denver Health Medical Center, Denver, Colorado
Mid-America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
Denver Veterans Administration Medical Center, Denver, Colorado

Manuscript received April 8, 2004; revised manuscript received August 31, 2004, accepted September 6, 2004.

^* Reprint requests and correspondence: Dr. Edward P. Havranek, Denver Health Medical Center #0960, 777 Bannock Street, Denver, Colorado 80204-4507 (Email: ehavrane{at}dhha.org).

OBJECTIVES: The objective of this study was to identify the factors associated with the development of depressive symptoms in outpatients with heart failure (HF).

BACKGROUND: Depression is common in patients with HF and has been linked to adverse outcomes.

METHODS: This was a multicenter prospective cohort study of outpatients with HF and ejection fraction <0.40. Patients were evaluated at baseline and one year with a Medical Outcomes Study-Depression questionnaire, a Kansas City Cardiomyopathy Questionnaire (KCCQ), and a full clinical evaluation including patients' social and economic status.

RESULTS: Of 245 patients without depressive symptoms at baseline, 52 (21.2%) developed depressive symptoms one year later. In multivariable analysis, living alone, alcohol abuse, perception of medical care as being a substantial economic burden, and health status as measured by the KCCQ were independent predictors of developing depressive symptoms. For patients without these factors, 7.9% developed depression by one year. When one factor was present, the one-year incidence was 15.5%, when two were present the incidence was 36.2%, and when three were present the incidence was 69.2%. There was a graded relationship between poorer health status and increased risk of developing depression (p < 0.001 for trend). No traditional clinical factors or measures of disease severity were significantly associated with the development of depression.

CONCLUSIONS: Social factors and health status are predictive of the development of depression in outpatients with HF. Clinicians should be aware of which patients are at risk for the development of depression so that these patients may be targeted for screening and potentially for psychosocial intervention.

Abbreviations and Acronyms   HF = heart failure   KCCQ = Kansas City Cardiomyopathy Questionnaire   MOS-D = Medical Outcomes Study-Depression questionnaire

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