Depression-Mortality Link in Heart Failure

Depression raises the risk of death among people with heart failure, according to recent research.

“Patients with heart failure are at high risk of recurrent hospital admissions and death,” said researcher Professor John Cleland of Imperial College London, UK.

Cleland said approximately 25 percent of patients admitted to hospital with heart failure are readmitted for a variety of reasons within one month. Within one year, most patients will have had one or more readmissions and almost half will have died.

“This study was designed to investigate in a more holistic fashion than previously the predictors of and reasons for readmission and death,” he said. “This included social, mental and physical frailty, as well as comorbidities and the severity of heart failure.

“Depression has been reported to predict death in patients with heart failure but until now it was thought that this could be because depressed patients have more severe heart failure and more comorbidities.”

The study included 154 patients hospitalized with heart failure. Symptoms of depression were measured using the Hospital Anxiety and Depression Scale, showing that 103 patients were not depressed, 27 had mild depression, and 24 had moderate to severe depression. During the followup of 302 days on average, there were 27 deaths.

Analysis showed that those with moderate to severe depression had a five times higher risk of death than those with no or mild depression. The association remained once sex, age, high blood pressure, severity of heart failure, and comorbidities were taken into account. Individuals with a low depression score had an 80 percent lower risk of death.

“Our results show that depression is strongly associated with death during the year following discharge from hospital after an admission for the exacerbation of heart failure; we expect that the link persists beyond one year,” said Cleland at the annual meeting of the Heart Failure Association of the European Society of Cardiology in May in Seville, Spain.

“The association was independent of the severity of heart failure or the presence of comorbidities,” Cleland added.

“We know that depression is common in heart failure and affects 20 to 40 percent of patients. Depression is often related to loss of motivation, loss of interest in everyday activities, lower quality of life, loss of confidence, sleep disturbances, and change in appetite with corresponding weight change. This could explain the association we found between depression and mortality.”

He then pointed out that, while doctors are members of a caring profession and should be sympathetic to the patient’s plight, “I am not in favor of immediately prescribing antidepressants.”

This is because studies suggest they are not effective in reducing depression in patients with heart failure,” Cleland said. “Clinicians should, however, screen patients with heart failure for depression and consider referring those affected for counseling,” he added.

“Recognition and management of depression may reduce mortality for patients with heart failure,” he concluded. “More research is needed to find out what clinicians and patients themselves can do to manage depression. Better treatments for heart failure, comorbidities as well as depression itself may be required.”

A further study recently explored the differences in “self-care” behavior between heart failure patients with and without depression. Dr. Fariba Yaghoubinia and colleagues at the Zahedan University of Medical Sciences, Iran, said psychological factors affect the onset, exacerbation, and treatment of heart failure.

“Depression is an inhibiting factor in treatment of cardiovascular disease since it causes denial of disease, low motivation to follow treatment, prolonged diseases, interference with the treatment and care, delayed recovery, and frequent hospitalizations,” they write in the journal PLoS One.

“In addition, depressed patients with cardiovascular disease have lower self-care ability in comparison with nondepressed ones. Depressed patients have negative feelings about their physical health status and quality of life.

“Therefore, depression reduces the commitment of patients to medication regimes and it is not surprising if depressed patients with heart failure have no commitment to therapeutic recommendations such as diet modification and lifestyle changes such as exercise and physical activity, smoking cessation, and participation in rehabilitation and educational programs. Depression also reduces the efficacy of self-care training programs.”

Their study involved 70 hospitalized patients who had heart failure, and were assessed for depression and level of self-care. An intervention of four sessions of education on awareness, attitude, and adherence to self-care behaviors was provided.

This “had lower effects on the depressed patients with heart failure.” The team stated, “Therefore, before providing education for these patients, it is necessary to consider their psychological problems such as depression.”

References

www.escardio.org

Navidian, A. et al. The Effect of Self-Care Education on the Awareness, Attitude, and Adherence to Self-Care Behaviors in Hospitalized Patients Due to Heart Failure with and without Depression. PLoS One, 19 June 2015 doi: 10.1371/journal.pone.0130973