Depression and Health Status in Elderly Patients
Depression and Health Status in Elderly Patients
To determine the prevalence and effects of depression on health status among elderly outpatients with heart failure, the authors conducted a 6-month prospective cohort study of 139 older outpatients with heart failure managed in primary care and 80 of their spouses. Primary care heart failure diagnosis was confirmed through chart review. The Primary Care Evaluation of Mental Disorders psychiatric diagnostic interview and Hamilton Depression Rating Scale were administered by phone. EQ-5D feeling thermometer, Medical Outcomes Study Short Form 36-Item Questionnaire, Kansas City Cardiomyopathy Questionnaire, and heart failure symptom severity questionnaires were administered by self-report. Depression diagnoses at baseline were: major depression and/or dysthymia (n=12, 9%), minor depression (n=14, 10%), and no depression (n=113, 81%). After adjusting for age, gender, and medical comorbidity, these depression groups differed by repeated measures analysis of covariance on most health status measures including the EQ-5D feeling thermometer; Medical Outcomes Study Short Form 36-Item Questionnaire general health and physical role function subscales; Kansas City Cardiomyopathy Questionnaire total score, symptom total, physical limitations, and quality of life subscales; as well as severity of chest pain and fatigue. Depression has significant and persistent effects on health status of elderly patients with heart failure, including heart failure symptoms, physical and role function, and quality of life. This may help explain why depression has been associated with increased health care utilization and costs in this population.
Congestive heart failure (CHF) is the only cardiovascular disease that is increasing in incidence, prevalence, mortality, and cost. CHF is now the leading cause for hospitalization in those over age 65 years and the most costly cardiovascular disease in the United States, with 1998 estimated total costs exceeding $20 billion. Most CHF management takes place in primary care. Compared with cardiologists' patients, primary care CHF patients are more likely to be older, to be women, to have a nonischemic etiology, and to have normal ejection fractions. Heart failure management for the elderly has classically focused on reversing or promoting adaptation to myocardial impairment. But there is increasing recognition that behavioral and other patient-level factors are important determinants of clinical outcome.
Depression has a well demonstrated association with adverse outcomes in coronary disease, but its effects on patients with heart failure are less well defined. The prevalence of major depression among CHF inpatients has been reported to be 14%-36% but studies of outpatients have relied on questionnaires assessing only depression symptoms. Recent prospective studies have suggested that depression symptoms independently increase the risk of developing heart failure among older adults. Major depression, depression symptoms. or a chart diagnosis of depression have been shown to increase mortality in CHF patients over 3-48 months.
Some prospective studies of CHF patients have shown that depression symptoms predict functional impairment (self-report of activities of daily living) over 6-12 months. But there is concern that this represents a reporting bias rather than a true functional deficit due to an absence of differences in 6-minute walk distance or maximum oxygen consumption in other studies. These studies also did not use validated depression diagnostic criteria. We therefore prospectively studied the relationship of depression, diagnosed by structured psychiatric interview, to self-reported health status, including self- and spouse-reported functional status, in a sample of elderly patients from primary care clinics who were diagnosed with CHF.
To determine the prevalence and effects of depression on health status among elderly outpatients with heart failure, the authors conducted a 6-month prospective cohort study of 139 older outpatients with heart failure managed in primary care and 80 of their spouses. Primary care heart failure diagnosis was confirmed through chart review. The Primary Care Evaluation of Mental Disorders psychiatric diagnostic interview and Hamilton Depression Rating Scale were administered by phone. EQ-5D feeling thermometer, Medical Outcomes Study Short Form 36-Item Questionnaire, Kansas City Cardiomyopathy Questionnaire, and heart failure symptom severity questionnaires were administered by self-report. Depression diagnoses at baseline were: major depression and/or dysthymia (n=12, 9%), minor depression (n=14, 10%), and no depression (n=113, 81%). After adjusting for age, gender, and medical comorbidity, these depression groups differed by repeated measures analysis of covariance on most health status measures including the EQ-5D feeling thermometer; Medical Outcomes Study Short Form 36-Item Questionnaire general health and physical role function subscales; Kansas City Cardiomyopathy Questionnaire total score, symptom total, physical limitations, and quality of life subscales; as well as severity of chest pain and fatigue. Depression has significant and persistent effects on health status of elderly patients with heart failure, including heart failure symptoms, physical and role function, and quality of life. This may help explain why depression has been associated with increased health care utilization and costs in this population.
Congestive heart failure (CHF) is the only cardiovascular disease that is increasing in incidence, prevalence, mortality, and cost. CHF is now the leading cause for hospitalization in those over age 65 years and the most costly cardiovascular disease in the United States, with 1998 estimated total costs exceeding $20 billion. Most CHF management takes place in primary care. Compared with cardiologists' patients, primary care CHF patients are more likely to be older, to be women, to have a nonischemic etiology, and to have normal ejection fractions. Heart failure management for the elderly has classically focused on reversing or promoting adaptation to myocardial impairment. But there is increasing recognition that behavioral and other patient-level factors are important determinants of clinical outcome.
Depression has a well demonstrated association with adverse outcomes in coronary disease, but its effects on patients with heart failure are less well defined. The prevalence of major depression among CHF inpatients has been reported to be 14%-36% but studies of outpatients have relied on questionnaires assessing only depression symptoms. Recent prospective studies have suggested that depression symptoms independently increase the risk of developing heart failure among older adults. Major depression, depression symptoms. or a chart diagnosis of depression have been shown to increase mortality in CHF patients over 3-48 months.
Some prospective studies of CHF patients have shown that depression symptoms predict functional impairment (self-report of activities of daily living) over 6-12 months. But there is concern that this represents a reporting bias rather than a true functional deficit due to an absence of differences in 6-minute walk distance or maximum oxygen consumption in other studies. These studies also did not use validated depression diagnostic criteria. We therefore prospectively studied the relationship of depression, diagnosed by structured psychiatric interview, to self-reported health status, including self- and spouse-reported functional status, in a sample of elderly patients from primary care clinics who were diagnosed with CHF.
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