LETTER TO THE EDITOR
Depression in older adults with heart failure
Ali Ahmed, MD, MPH, FACC*
* Division of Geriatric Medicine and Geriatric Heart Failure, Clinic University of Alabama at Birmingham, Section of Geriatrics and Geriatric Heart Failure Clinic, Birmingham VA Medical Center, Suite CH19-219, 1530 3rd Avenue South, Birmingham, AL 35294-2041 (Email: aahmed{at}uab.edu).
We read with great interest the study by Gottlieb et al. (1), which examined an important area in heart failure (HF) management: depression. The investigators observed that for every 10 years above the mean age (64 years), "the likelihood of exhibiting depressive symptoms decreased by 26%." This is surprising as depression is rather common in old age. About 20% of the U.S. population 65 years and older suffer from depression, compared with 7% in younger adults (2,3).
Many of these older adults suffer from subsyndromal or atypical depression, which is much more common in old age, more difficult to diagnose, and is as distressing and disabling as major depression (2–4). The vast majority of HF patients are 65 years or older, many have preserved systolic function, and they receive care from generalist physicians in nonacademic settings. The results of this interesting study of depression in relatively younger male HF patient with systolic dysfunction receiving care from a cardiology clinic in an academic setting may not be generalizable to most HF patients.
Focusing on "relatively young" patients may not be the most efficient way to screen depression in HF, and certainly not in older adults. In addition, use of the Geriatric Depression Scale, instead of the Structured Clinical Interview described in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition–Revised (DSM–III-R) or other diagnostic tools such as Beck Depression Inventory, is more likely to identify depression in older adults (5).
Finally, care settings also likely have significant implications for appropriate diagnosis and management of depression in older adults with HF. Older adults with HF should preferably receive primary care from a generalist physician, in consultation with a cardiologist (6). The American College of Cardiology/American Heart Association guidelines for chronic HF has identified this collaborative model as the most preferred model for HF management (7).
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1. Gottlieb SS, Khatta M, Friedmann E, et al. The influence of age, gender, and race on the prevalence of depression in heart failure patients J Am Coll Cardiol 2004;43:1542-1549.[Abstract/Free Full Text]
2. Office of the Surgeon General Depression in older adults. Mental health: A report of the Surgeon Generalhttp://www.surgeongeneral.gov/library/mentalhealth/chapter5/sec3.html 2004Accessed May 4, 2004.
3. The National Institute of Mental Health Older Adults: Depression and Suicide Facts. A brief overview of the statistics on depression and suicide in older adults, with information on depression treatments and suicide preventionhttp://www.nimh.nih.gov/publicat/elderlydepsuicide.cfm#4 2004Accessed May 4, 2004.
4. Matza LS, Revicki DA, Davidson JR, Stewart JW. Depression with atypical features in the National Comorbidity Survey: classification, description, and consequences Arch Gen Psychiatry 2003;60:817-826.[Abstract/Free Full Text]
5. Fulop G, Strain JJ, Stettin G. Congestive heart failure and depression in older adults: clinical course and health services' use 6 months after hospitalization Psychosomatics 2003;44:367-373.[Abstract/Free Full Text]
6. Ahmed A, Allman RM, Kiefe CI, et al. Association of consultation between generalists and cardiologists with quality and outcomes of heart failure care Am Heart J 2003;145:1086-1093.[CrossRef][Medline]
7. Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summaryA report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2001;38:2101-2113.[Free Full Text]
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