Relationship Between Depressive Symptoms and Long-Term Mortality in Patient
Relationship Between Depressive Symptoms and Long-Term Mortality in Patient
Background: Depression is prevalent in patients with heart failure (HF) and is associated with short-term poor prognosis. However, the long-term effect of depression and the use of self-administered depression evaluation on HF prognosis remained unknown. The study sought to assess the association of depressive symptoms and long-term mortality of patients with HF and to explore the prognostic predictability of the Beck Depression Inventory (BDI) scale for patients with HF.
Methods: Hospitalized patients with HF between March 1997 and June 2003 were recruited. All participants were given the self-administered BDI scale for depression assessment during the index admission. They were then followed for 6 months for the collection of vital status, and annually thereafter.
Results: Total study population comprises 1006 patients. The mean BDI score was 8.3 ± 7.1. The average days of follow-up were 971 ± 730 and the vital status was obtained from all participants. During this period, 42.6% of the participants died. Depression (defined by BDI score ≥10) was significantly and independently associated with reduced survival (adjusted hazard ratio 1.36, 95% CI 1.09-1.70, P < .001). Patients whose BDI scores were 5 to 9, 10 to 18, and ≥19 were 21%, 53%, and 83% more likely to die, respectively, than patients whose BDI score was <5 (P < .001).
Conclusions: Self-rated depression by BDI is independently linked with higher long-term mortality in patients with HF. Significant dose effect of depressive symptoms on higher mortality is noted.
Heart failure (HF) has been a public health issue in the United States. About 5 million Americans live with HF, with 550000 new cases diagnosed yearly. New HF cases are predicted to reach 1.5 million by 2040 as the population ages and more people survive acute myocardial infarctions (MIs).
Heart failure carries grave clinical and societal consequences. The risk of mortality is 6 to 9 times higher in patients with HF than in the general population. Approximately 50% of patients are readmitted within 6 months after discharge following a hospitalization for HF. Heart failure costs are the largest expenditure category and most common discharge diagnosis among Medicare beneficiaries.
Depression is frequent with HF. It is associated with increased morbidity and mortality in these patients during short-term follow-up, but its association with longer-term outcomes is unknown. Furthermore, the ability of a self-administered depression assessment to predict prognosis in patients with HF has not been well evaluated. Previous studies have used structured psychiatric interviews to assess depression, which is costly and time-consuming and confers limited ability to generalize the findings to other settings.
The objective of this study therefore was to evaluate the use of a simple, patient-administered tool to evaluate depression in hospitalized patients with HF and the predictability of depressive symptoms, by using the cutoff value as well as by using the continuous value, for long-term mortality. Symptoms of depression were assessed by the self-administered questionnaire, the Beck Depression Inventory (BDI) scale.
Background: Depression is prevalent in patients with heart failure (HF) and is associated with short-term poor prognosis. However, the long-term effect of depression and the use of self-administered depression evaluation on HF prognosis remained unknown. The study sought to assess the association of depressive symptoms and long-term mortality of patients with HF and to explore the prognostic predictability of the Beck Depression Inventory (BDI) scale for patients with HF.
Methods: Hospitalized patients with HF between March 1997 and June 2003 were recruited. All participants were given the self-administered BDI scale for depression assessment during the index admission. They were then followed for 6 months for the collection of vital status, and annually thereafter.
Results: Total study population comprises 1006 patients. The mean BDI score was 8.3 ± 7.1. The average days of follow-up were 971 ± 730 and the vital status was obtained from all participants. During this period, 42.6% of the participants died. Depression (defined by BDI score ≥10) was significantly and independently associated with reduced survival (adjusted hazard ratio 1.36, 95% CI 1.09-1.70, P < .001). Patients whose BDI scores were 5 to 9, 10 to 18, and ≥19 were 21%, 53%, and 83% more likely to die, respectively, than patients whose BDI score was <5 (P < .001).
Conclusions: Self-rated depression by BDI is independently linked with higher long-term mortality in patients with HF. Significant dose effect of depressive symptoms on higher mortality is noted.
Heart failure (HF) has been a public health issue in the United States. About 5 million Americans live with HF, with 550000 new cases diagnosed yearly. New HF cases are predicted to reach 1.5 million by 2040 as the population ages and more people survive acute myocardial infarctions (MIs).
Heart failure carries grave clinical and societal consequences. The risk of mortality is 6 to 9 times higher in patients with HF than in the general population. Approximately 50% of patients are readmitted within 6 months after discharge following a hospitalization for HF. Heart failure costs are the largest expenditure category and most common discharge diagnosis among Medicare beneficiaries.
Depression is frequent with HF. It is associated with increased morbidity and mortality in these patients during short-term follow-up, but its association with longer-term outcomes is unknown. Furthermore, the ability of a self-administered depression assessment to predict prognosis in patients with HF has not been well evaluated. Previous studies have used structured psychiatric interviews to assess depression, which is costly and time-consuming and confers limited ability to generalize the findings to other settings.
The objective of this study therefore was to evaluate the use of a simple, patient-administered tool to evaluate depression in hospitalized patients with HF and the predictability of depressive symptoms, by using the cutoff value as well as by using the continuous value, for long-term mortality. Symptoms of depression were assessed by the self-administered questionnaire, the Beck Depression Inventory (BDI) scale.
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