STATE-OF-THE-ART PAPER
Depression in Heart Failure
A Meta-Analytic Review of Prevalence, Intervention Effects, and Associations With Clinical Outcomes
Thomas Rutledge, PhD*, ,*,
Veronica A. Reis, BSc*, ,
Sarah E. Linke, BA ,
Barry H. Greenberg, MD, FACC and
Paul J. Mills, PhD
* VA San Diego Health Care System, San Diego, California
University of California, San Diego, San Diego, California
University of Southern California, Los Angeles, California
San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California. David S. Sheps, MD, MSPH, acted as the guest editor for this article
Manuscript received March 6, 2006;
revised manuscript received May 10, 2006,
accepted June 16, 2006.
* Reprint requests and correspondence: Dr. Thomas Rutledge, VA San Diego Healthcare System, Psychology Service (116B), 3350 La Jolla Village Drive, San Diego, California 92161. (Email: Thomas.Rutledge{at}va.gov).
This article describes a meta-analysis of published associations between depression and heart failure (HF) in regard to 3 questions: 1) What is the prevalence of depression among patients with HF? 2) What is the magnitude of the relationship between depression and clinical outcomes in the HF population? 3) What is the evidence for treatment effectiveness in reducing depression in HF patients? Key word searches of the Medline and PsycInfo databases, as well as reference searches in published HF and depression articles, identified 36 publications meeting our criteria. Clinically significant depression was present in 21.5% of HF patients, and varied by the use of questionnaires versus diagnostic interview (33.6% and 19.3%, respectively) and New York Heart Association–defined HF severity (11% in class I vs. 42% in class IV), among other factors. Combined results suggested higher rates of death and secondary events (risk ratio = 2.1, 95% confidence interval 1.7 to 2.6), trends toward increased health care use, and higher rates of hospitalization and emergency room visits among depressed patients. Treatment studies generally relied on small samples, but also suggested depression symptom reductions from a variety of interventions. In sum, clinically significant depression is present in at least 1 in 5 patients with HF; however, depression rates can be much higher among patients screened with questionnaires or with more advanced HF. The relationship between depression and poorer HF outcomes is consistent and strong across multiple end points. These findings reinforce the importance of psychosocial research in HF populations and identify a number of areas for future study.
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Abbreviations and Acronyms
| | BDI = Beck Depression Inventory | | CAD = coronary artery disease | | HF = heart failure | | IL = interleukin | | NYHA = New York Heart Association |
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59(3):
291 - 291.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. Celano, C. A. Mastromauro, E. C. Lenihan, J. L. Januzzi, B. L. Rollman, and J. C. Huffman
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74(1):
93 - 99.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Ehmke
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Cardiovasc Res,
January 1, 2012;
93(1):
6 - 7.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. L. A. Luttik, T. Jaarsma, R. Sanderman, and J. Fleer
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European Journal of Cardiovascular Nursing,
December 1, 2011;
10(4):
228 - 233.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Sanchez, M. T. Vidan, J. A. Serra, F. Fernandez-Aviles, and H. Bueno
Prevalence of geriatric syndromes and impact on clinical and functional outcomes in older patients with acute cardiac diseases
Heart,
October 1, 2011;
97(19):
1602 - 1606.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Grande, M. Romppel, J.-M. Vesper, R. Schubmann, H. Glaesmer, and C. Herrmann-Lingen
Type D Personality and All-Cause Mortality in Cardiac Patients--Data From a German Cohort Study
Psychosom Med,
September 1, 2011;
73(7):
548 - 556.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. C. Coyne, T. Jaarsma, M.-L. Luttik, E. van Sonderen, D. J. van Veldhuisen, and R. Sanderman
Lack of Prognostic Value of Type D Personality for Mortality in a Large Sample of Heart Failure Patients
Psychosom Med,
September 1, 2011;
73(7):
557 - 562.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. BLUMENTHAL
New frontiers in cardiovascular behavioral medicine: Comparative effectiveness of exercise and medication in treating depression
Cleveland Clinic Journal of Medicine,
August 1, 2011;
78(Suppl_1):
S35 - S43.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. J. Pressler, U. Subramanian, S. M. Perkins, I. Gradus-Pizlo, D. Kareken, J. Kim, Y. Ding, M. J. Sauve, and R. Sloan
Measuring Depressive Symptoms in Heart Failure: Validity and Reliability of the Patient Health Questionnaire-8
Am. J. Crit. Care.,
March 1, 2011;
20(2):
146 - 152.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. C. Huffman, C. A. Mastromauro, G. Sowden, G. L. Fricchione, B. C. Healy, and J. L. Januzzi
Impact of a Depression Care Management Program for Hospitalized Cardiac Patients
Circ Cardiovasc Qual Outcomes,
March 1, 2011;
4(2):
198 - 205.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Connerney and P. A. Shapiro
Assessment of Depression in Heart Failure Patients: What Is the Role for Cardiology?
J. Am. Coll. Cardiol.,
January 25, 2011;
57(4):
424 - 426.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. S. Redwine, P. H. Wirtz, S. Hong, J. Bosch, M. G. Ziegler, B. Greenberg, and P. J. Mills
Depression as a Potential Modulator of Beta-Adrenergic-Associated Leukocyte Mobilization in Heart Failure Patients
J. Am. Coll. Cardiol.,
November 16, 2010;
56(21):
1720 - 1727.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. T. Artinian and B. Franklin
Counseling African Americans in Cardiac Rehabilitation: Implications for Comprehensive Lifestyle Modification
American Journal of Lifestyle Medicine,
November 1, 2010;
4(6):
490 - 499.
[Abstract]
[PDF]
|
|
|
|
|
|
|
F. Kendel, G. Gelbrich, M. Wirtz, E. Lehmkuhl, N. Knoll, R. Hetzer, and V. Regitz-Zagrosek
Predictive Relationship Between Depression and Physical Functioning After Coronary Surgery
Arch Intern Med,
October 25, 2010;
170(19):
1717 - 1721.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Bergvik, T. Sorlie, and R. Wynn
Approach and Avoidance Coping and Regulatory Focus in Patients Having Coronary Artery Bypass Graft Surgery
J Health Psychol,
September 1, 2010;
15(6):
915 - 924.
[Abstract]
[PDF]
|
|
|
|
|
|
|
E. A. Jankowska, A. Drohomirecka, B. Ponikowska, A. Witkowska, M. Lopuszanska, A. Szklarska, L. Borodulin-Nadzieja, W. Banasiak, P. A. Poole-Wilson, and P. Ponikowski
Deficiencies in circulating testosterone and dehydroepiandrosterone sulphate, and depression in men with systolic chronic heart failure
Eur J Heart Fail,
September 1, 2010;
12(9):
966 - 973.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. O'Connor, W. Jiang, M. Kuchibhatla, S. G. Silva, M. S. Cuffe, D. D. Callwood, B. Zakhary, W. G. Stough, R. M. Arias, S. K. Rivelli, et al.
Safety and Efficacy of Sertraline for Depression in Patients With Heart Failure: Results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) Trial
J. Am. Coll. Cardiol.,
August 24, 2010;
56(9):
692 - 699.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. J. Goodlin
Sadness in Heart Failure: What Is a Clinician to Do?
J. Am. Coll. Cardiol.,
August 24, 2010;
56(9):
700 - 701.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. SILVER
Depression and heart failure: An overview of what we know and don't know
Cleveland Clinic Journal of Medicine,
July 1, 2010;
77(Suppl_3):
S7 - S11.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Abramowitz and C. Ani
GPs good at ruling out depression in primary care, but false positives common
Evid. Based Med.,
February 1, 2010;
15(1):
29 - 30.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. D. Adler, J. Z. Goldfinger, J. Kalman, M. E. Park, and D. E. Meier
Palliative Care in the Treatment of Advanced Heart Failure
Circulation,
December 22, 2009;
120(25):
2597 - 2606.
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Lesman-Leegte, D. J. van Veldhuisen, H. L. Hillege, D. Moser, R. Sanderman, and T. Jaarsma
Depressive symptoms and outcomes in patients with heart failure: data from the COACH study
Eur J Heart Fail,
December 1, 2009;
11(12):
1202 - 1207.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. L. Chung, T. A. Lennie, B. Riegel, J.-R. Wu, R. L. Dekker, and D. K. Moser
Marital Status as an Independent Predictor of Event-Free Survival of Patients With Heart Failure
Am. J. Crit. Care.,
November 1, 2009;
18(6):
562 - 570.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. T. Parissis, D. Farmakis, M. Nikolaou, D. Birmpa, V. Bistola, I. Paraskevaidis, I. Ikonomidis, S. Gaitani, K. Venetsanou, G. Filippatos, et al.
Plasma B-type natriuretic peptide and anti-inflammatory cytokine interleukin-10 levels predict adverse clinical outcome in chronic heart failure patients with depressive symptoms: a 1-year follow-up study
Eur J Heart Fail,
October 1, 2009;
11(10):
967 - 972.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Riegel, D. K. Moser, S. D. Anker, L. J. Appel, S. B. Dunbar, K. L. Grady, M. Z. Gurvitz, E. P. Havranek, C. S. Lee, J. Lindenfeld, et al.
State of the Science: Promoting Self-Care in Persons With Heart Failure: A Scientific Statement From the American Heart Association
Circulation,
September 22, 2009;
120(12):
1141 - 1163.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Whang and K. W. Davidson
Is It Time to Treat Depression in Patients With Cardiovascular Disease?
Circulation,
July 14, 2009;
120(2):
99 - 100.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Frasure-Smith, F. Lesperance, M. Habra, M. Talajic, P. Khairy, P. Dorian, D. Roy, and for the Atrial Fibrillation and Congestive Heart F
Elevated Depression Symptoms Predict Long-Term Cardiovascular Mortality in Patients With Atrial Fibrillation and Heart Failure
Circulation,
July 14, 2009;
120(2):
134 - 140.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. Clark, C. N. Freydberg, F. A. McAlister, R. T. Tsuyuki, P. W. Armstrong, and L. A. Strain
Patient and informal caregivers' knowledge of heart failure: necessary but insufficient for effective self-care
Eur J Heart Fail,
June 1, 2009;
11(6):
617 - 621.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Jaarsma, J. M. Beattie, M. Ryder, F. H. Rutten, T. McDonagh, P. Mohacsi, S. A. Murray, T. Grodzicki, I. Bergh, M. Metra, et al.
Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology
Eur J Heart Fail,
May 1, 2009;
11(5):
433 - 443.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.E. Angermann
Comorbidities in heart failure: a key issue
Eur J Heart Fail Suppl,
April 1, 2009;
8(suppl_1):
i5 - i10.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. J. Pressler, I. Gradus-Pizlo, S. D. Chubinski, G. Smith, S. Wheeler, J. Wu, and R. Sloan
Family Caregiver Outcomes in Heart Failure
Am. J. Crit. Care.,
March 1, 2009;
18(2):
149 - 159.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Ani, M. Bazargan, D. Hindman, D. Bell, M. Rodriguez, and R. S. Baker
Comorbid Chronic Illness and the Diagnosis and Treatment of Depression in Safety Net Primary Care Settings
J Am Board Fam Med,
March 1, 2009;
22(2):
123 - 135.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. P. Coletta, A. L. Clark, and J. G.F. Cleland
Clinical trials update from the Heart Failure Society of America and the American Heart Association meetings in 2008: SADHART-CHF, COMPARE, MOMENTUM, thyroid hormone analogue study, HF-ACTION, I-PRESERVE, {beta}-interferon study, BACH, and ATHENA
Eur J Heart Fail,
February 1, 2009;
11(2):
214 - 219.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. S. Pedersen, N. Kupper, and J. Denollet
CHAPTER 35 Psychological Factors and Heart Disease
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. D. Thombs, P. de Jonge, J. C. Coyne, M. A. Whooley, N. Frasure-Smith, A. J. Mitchell, M. Zuidersma, C. Eze-Nliam, B. B. Lima, C. G. Smith, et al.
Depression Screening and Patient Outcomes in Cardiovascular Care: A Systematic Review
JAMA,
November 12, 2008;
300(18):
2161 - 2171.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. H. Lichtman, J. T. Bigger Jr, J. A. Blumenthal, N. Frasure-Smith, P. G. Kaufmann, F. Lesperance, D. B. Mark, D. S. Sheps, C. B. Taylor, and E. S. Froelicher
Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment: A Science Advisory From the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association
Circulation,
October 21, 2008;
118(17):
1768 - 1775.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Eur. Heart J.,
October 1, 2008;
29(19):
2388 - 2442.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Eur J Heart Fail,
October 1, 2008;
10(10):
933 - 989.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Herrmann-Lingen and B. Pieske
Natriuretic peptides or psychometric tests? Prognostic markers in congestive heart failure
Heart,
May 1, 2008;
94(5):
545 - 546.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. E. Angermann, G. Gelbrich, S. Stork, A. Fallgatter, J. Deckert, H. Faller, G. Ertl, and on behalf of the MOOD-HF Investigators
Rationale and design of a randomised, controlled, multicenter trial investigating the effects of selective serotonin re-uptake inhibition on morbidity, mortality and mood in depressed heart failure patients (MOOD-HF)
Eur J Heart Fail,
December 1, 2007;
9(12):
1212 - 1222.
[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]
|
|
|
|
|
|
|
T. Rutledge, V. A. Reis, and S. E. Linke
Reply
J. Am. Coll. Cardiol.,
April 3, 2007;
49(13):
1504 - 1504.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Persaud
Depression and Heart Failure: Why the Link Continues to Elude Us
J. Am. Coll. Cardiol.,
April 3, 2007;
49(13):
1503 - 1504.
[Full Text]
[PDF]
|
|
|
|
