Depression in Heart Failure. A Meta-Analytic Review of Prevalence, Intervention Effects, and Associations With Clinical Outcomes

San Diego State University, San Diego, California, United States
Journal of the American College of Cardiology (Impact Factor: 16.5). 11/2006; 48(8):1527-37. DOI: 10.1016/j.jacc.2006.06.055
Source: PubMed


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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Available from: Thomas Rutledge, Oct 04, 2015
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    • "These findings also have significant implications for other chronic illness populations in which depression is comorbid (e.g. diabetes, Anderson et al., 2001; chronic kidney disease, Palmer et al., 2013; and heart failure, Rutledge et al., 2006). Our findings suggest that not all depression questionnaires may be appropriate for assessing depressive symptomatology in chronic illness populations. "
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    ABSTRACT: Introduction: Depression is common in chronic illness, albeit prevalence can be highly variable. This variability may be a function of symptom overlap between depression and chronic illness. Using Obstructive Sleep Apnoea (OSA) as an exemplar, this meta-analysis explored whether the proportion of overlapping symptoms between OSA and depression, within different depression questionnaires, moderates prevalence estimates. Methods: A systematic search identified 13 studies meeting eligibility criteria. Results: Based on depression questionnaires, the prevalence of depression in OSA ranged from 8% – 68%, reflecting marked heterogeneity. Prevalence estimates based on questionnaires with greater symptom overlap between OSA and depression were higher, whilst questionnaires with a higher proportion of anhedonia symptoms were associated with lower prevalence estimates. Discussion: Overall, these data suggest that when using depression questionnaires to assess the prevalence of depression in OSA, questionnaires that have a lower proportion of symptom overlap between OSA and depression, as well as a higher proportion of anhedonia symptoms, reduce the likelihood of overestimating the prevalence of depression in OSA. This study has implications for other chronic illnesses with symptom overlap with depression, for example diabetes, chronic kidney disease or heart disease, as well as suggesting that depression questionnaires are not equally appropriate for assessing depression symptomatology in chronic illness populations.
    Health Psychology 08/2015; In press. · 3.59 Impact Factor
    • "Immun. (2015), mortality rates have been established (Rutledge et al., 2006). The first reports of a higher incidence of CHD-related deaths in patients suffering from major depression originate from 1930 (Malzberg, 1937). "
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    ABSTRACT: Cardiovascular disease (CVD) remains a leading cause of death worldwide and identification and therapeutic modulation of all its risk factors is necessary to ensure a lower burden on the patient and on society. The physiological response to acute and chronic stress exposure has long been recognized as a potent modulator of immune, endocrine and metabolic pathways, however its direct implications for cardiovascular disease development, progression and as a therapeutic target are not completely understood. More and more attention is given to the bidirectional interaction between psychological and physical health in relation to cardiovascular disease. With atherosclerosis being a chronic disease starting already at an early age the contribution of adverse early life events in affecting adult health risk behavior, health status and disease development is receiving increased attention. In addition, experimental research into the biological pathways involved in stress-induced cardiovascular complications show important roles for metabolic and immunologic maladaptation, resulting in increased disease development and progression. Here we provide a concise overview of human and experimental animal data linking chronic and acute stress to CVD risk and increased progression of the underlying disease atherosclerosis. Copyright © 2015. Published by Elsevier Inc.
    Brain Behavior and Immunity 08/2015; DOI:10.1016/j.bbi.2015.08.007 · 5.89 Impact Factor
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    • "The independent prognostic power of depressive symptoms is consistent with previous research [1] [2] [18]. Several mechanisms have been proposed to explain the effects of depression on mortality in cardiovascular diseases [19] [20]. "
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    ABSTRACT: The prognostic potential of depressive symptoms independent of somatic features of heart failure severity has repeatedly been demonstrated. However, patient-reported functional status has rarely been accounted for in these studies. Thus, it has remained unclear to what extent the predictive power of depressive symptoms may mirror functional status. We therefore aimed to evaluate the prognostic value of depressive symptoms adjusting for patient-reported functional status in a large, well-characterized sample of patients with systolic heart failure. Eight hundred sixty-three patients, 67±12years old, 72% men, and 42% with New York Heart Association functional classes III/IV, who participated in the extended Interdisciplinary Network Heart Failure (INH) study were investigated. We assessed depressive symptoms using the Patient Health Questionnaire (PHQ-9) and patient-reported functional status with the Kansas City Cardiomyopathy Questionnaire (KCCQ). Data on survival was obtained after a follow-up of 18months (100% complete). Depressive symptoms predicted mortality risk (HR per PHQ-9 scale point=1.07, 95% CI 1.04-1.09, p<.001), even after adjustment for heart failure severity and co-morbidities (HR=1.04, 95% CI 1.01-1.07, p=.017). However, they were no longer significant predictors (HR=1.01, 95% CI 0.98-1.05, p=0.46) after additional adjustment for patient-reported functional status, which proved predictive of mortality risk (HR=0.90, 95% CI 0.82-0.99, p=.025). Our results suggest that the association of depressive symptoms with functional status may at least partly explain the prognostic potential of depressive symptoms. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Psychosomatic Research 03/2015; 48(6). DOI:10.1016/j.jpsychores.2015.02.015 · 2.74 Impact Factor
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