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ABSTRACT: AIMS: Heart failure is known to profoundly affect health-related quality of life (HRQoL). We aimed to describe both generic and disease-specific HRQoL in a large community-based sample of patients with systolic heart failure (SHF) and to identify important somatic and psychosocial correlates. METHODS AND RESULTS: Seven hundred and two patients, 67 ± 12 years old, 71 % men, with distributions of New York Heart Association (NYHA) functional classes I/II/III/IV of 2/55/39/4 % were included in this cross-sectional analysis. Generic HRQoL was measured with the SF-36 health survey, disease-specific HRQoL with the Kansas City Cardiomyopathy Questionnaire, and depression with the self-reported Patient Health Questionnaire (PHQ-9). Both generic- and disease-specific HRQoL measurements indicated moderate to poor HRQoL. The KCCQ scores demonstrated higher sensitivity to the varying levels of heart failure severity as compared to the SF-36 scores. Patients with either a minor (15 %) or a major depression (24 %) reported significantly and substantially lower HRQoL (p < .001) than patients without depression did. In multivariable regression analyses, depression accounted for the largest part of the variance of both generic and specific HRQoL (12 and 36 %, respectively), whereas most biomedical variables had no or only a marginal influence. CONCLUSION: Patients with SHF suffer from severe limitations of HRQoL. Depression was the most important correlate of both generic and disease-specific HRQoL.
Clinical Research in Cardiology 12/2012; · 2.95 Impact Factor
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International journal of cardiology 07/2012; · 7.08 Impact Factor
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ABSTRACT: Major depression is 4-5 times more common in heart failure than in the general population, and associated with adverse outcomes. This prospective study investigated somatic correlates of comorbid depression in patients with heart failure aiming to better understand the interrelation of both conditions.
We enrolled 702 consecutive patients hospitalized for heart failure with a left ventricular ejection fraction (LVEF) ≤ 40% (mean age 67 years, 71% male). Suspected episodes of depression were identified using the Patient Health Questionnaire (PHQ-9). A score >11 (9-11) was defined as suspected major (minor) depression.
The prevalence of major (minor) depression was 24% (15%). Major depression was more common in women (30%) than men (22%, p = 0.02). In multivariable analysis, history of depression, (OR 3.09, 95%CI 1.98-4.82, p < 0.001), New York Heart Association class (OR 2.07 per class, 95%CI 1.52-2.81, p<0.001), leukocyte count >8000/mm(3) (OR 1.50, 95%CI 1.03-2.17, p = 0.032), and obstructive pulmonary disease (OR 1.61, 95%CI 1.04-2.50, p = 0.033) correlated independently with higher prevalence rates of major depression. Hemoglobin (OR 0.87 per g/dL, 95%CI 0.79-0.96, p = 0.005), and treatment with 3-hydroxy-3-methylglutaryl-coenzyme-A-reductase inhibitors (OR 0.66, 95%CI 0.45-0.98, p = 0.039) correlated independently with lower prevalence rates. Female sex, diabetes, peripheral edema, hyperuricemia, cholesterol <150 mg/dL, LVEF <30%, peripheral vascular disease, diuretics, and renal dysfunction were predictive only in univariable models.
The high prevalence of major depression in patients with heart failure seems closely linked to various typical clinical features of this syndrome. Whether this implicates differential therapeutic needs in patients with comorbid compared with primary depression requires further investigation.
International journal of cardiology 09/2009; 147(1):66-73. · 7.08 Impact Factor
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ABSTRACT: To examine whether depression and heart failure severity are independent predictors of both the physical and psychologic domains of health-related quality of life (HRQoL) in patients with chronic heart failure.
A sample of 206 outpatients with chronic heart failure (mean age 64 years, 69% male) was evaluated. Depression was measured with the Patient Health Questionnaire and disease-specific HRQoL with the Kansas City Cardiomyopathy Questionnaire. Heart failure severity was assessed with physician ratings of the New York Heart Association (NYHA) functional class. The simultaneous effects of predictor variables on outcomes were estimated using structural equation modeling. Both depression and NYHA functional class independently predicted the physical domain of HRQoL. By contrast, the psychologic domain was only predicted by depression, but not by NYHA functional class.
Our results suggest that comorbid depression has an independent impact on both physical and psychologic HRQoL in patients with chronic heart failure after controlling for the severity of heart failure symptoms, while heart failure severity only impacts physical HRQoL. Thus, assessment of comorbid depression may help interpreting reduced HRQoL in heart failure patients. Research seems warranted evaluating whether the amelioration of depression may enhance patients' HRQoL in chronic heart failure.
Journal of cardiac failure 06/2009; 15(4):286-292.e2. · 3.25 Impact Factor
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ABSTRACT: Depression is highly prevalent in patients with chronic heart failure (CHF) and may bias patients' reports of their health-related quality of life (HRQoL). Depressed patients may rate their limitations of HRQoL worse even when their condition is rather good. We aimed to examine whether co-morbid depression alters the relationship between disease severity and HRQoL, thus compromising the validity of a CHF-specific HRQoL measure.
A sample of 233 outpatients with CHF (mean age 64.5 years, 70% male) was evaluated. Depression was measured with the Patient Health Questionnaire and CHF-specific HRQoL with the Kansas City Cardiomyopathy Questionnaire (KCCQ). CHF severity was assessed with physician ratings of the New York Heart Association (NYHA) functional class.
Both NYHA functional class and depression independently impacted the various subscales of the KCCQ. Regarding the symptom- and function-related subscales, a dose-response relationship between disease severity and HRQoL was observed also in depressed patients. In contrast, in the quality of life subscale covering life satisfaction an interaction effect of disease severity and depression was found. In this subscale, a dose-response relationship between increasing disease severity and worsening HRQoL was no longer present among the depressed.
Both disease severity and depression impacted each heart failure-specific HRQoL dimension while the presence of depression seemed to distort the relationship between disease severity and HRQoL in the quality of life subscale. As quality of life may depend more on the presence of depression than on the severity of CHF, assessing depression may help interpreting HRQoL scores.
International journal of cardiology 02/2009; 142(2):133-7. · 7.08 Impact Factor
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ABSTRACT: Long-term outcomes of gastric banding regarding depression and predictors of change in depression are still unclear. This prospective, controlled study investigated depression and self-acceptance in morbidly obese patients before and after gastric banding.
A total of 248 morbidly obese patients (mean body mass index [BMI] = 46.4, SD = 6.9) seeking gastric banding completed questionnaires for symptoms of depression (Beck Depression Inventory) and self-acceptance. One hundred twenty-eight patients were treated with gastric banding and 120 patients were not. After 5 to 7 years, patients who either had (n = 40) or had not (n = 42) received gastric banding were reassessed.
In the preoperative assessment, 35% of all obese patients suffered from clinically relevant depressive symptoms (BDI score > or =18). The mean depression score was higher and the mean self-acceptance score was lower than those of the normal population. Higher preoperative depression scores were observed among patients living alone and who had obtained low levels of education. After 5 to 7 years, patients with gastric banding had lost significantly more weight than patients without gastric banding (mean BMI loss 10.0 vs. 3.3). Gastric banding patients improved significantly in depression and self-acceptance, whereas no change was found in patients without gastric banding. Symptoms of depression were more reduced in patients who lost more weight, lived together with a partner, and had a high preoperative depression score.
Morbid obesity is associated with depressive symptoms and low self-acceptance. Gastric banding results in both long-term weight loss and improvement in depression and self-acceptance.
Obesity Surgery 04/2008; 18(3):314-20. · 3.29 Impact Factor
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ABSTRACT: In the present study, criteria were investigated to predict major benefit after laparoscopic adjustable gastric banding (LAGB).
85 morbidly obese patients were operated with LAGB between 1999 and 2005. Seventy-one of these patients were analyzed according to several possible predictive characteristics for success as the primary endpoint. Success was defined as excess body weight loss (EBWL) >50% and no band removal. Median follow-up was 27 months (range 8-90 months).
In total, median EBWL was 43% (-41 to 171.5%) with a decrease in BMI of 8.0 kg/m(2) (-9 to 35 kg/m(2)). Success rate was 37% (n = 26). These patients were compared to all other patients (n = 45). Significant success predictors were baseline absolute BW, EBW, BMI (p < 0.01), BMI with a threshold value of 50 kg/m(2) (p = 0.02), and female sex (p = 0.02) as well as postoperative vomiting (p = 0.02), eating behavior and physical activity after LAGB (p < 0.01). Baseline EBW and change in eating behavior after surgery were identified as independent predictors in multivariate analysis.
Patients with a lower excess body weight who improve especially their eating behavior after surgery have the highest chance of success after LAGB.
Obesity Surgery 12/2007; 17(12):1608-13. · 3.29 Impact Factor
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ABSTRACT: The aim of this study was to examine whether the physical and mental components of health-related quality of life (HRQoL) are independent predictors of survival in patients with chronic heart failure (CHF).
A cohort of 231 outpatients with CHF was followed prospectively for 986 days (median; interquartile range=664-1120). Generic HRQoL was measured with the Short Form-36 Health Survey (SF-36), disease-specific HRQoL was measured with the Kansas City Cardiomyopathy Questionnaire, and depression was measured with the self-reported Patient Health Questionnaire.
Both generic and disease-specific HRQoL were predictive of survival on univariate analyses. After adjustment for prognostic factors such as age, gender, degree of left ventricular dysfunction, and functional status, only the mental health component of SF-36 and the disease-specific HRQoL remained significant. When depression was included, both measures also lost their predictive power.
Our data suggest that the prognostic value of patients' HRQoL reflects confounding with the severity of disease and comorbid depression.
Journal of Psychosomatic Research 12/2007; 63(5):533-8. · 3.30 Impact Factor
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ABSTRACT: Data regarding the influence of depression on outcome in chronic heart failure are conflicting and neglect possible gender differences.
To investigate prevalence and prognostic importance of depression in a cohort of patients with symptomatic heart failure and to compare findings in males and females.
Depression was measured at study entry using a self-reported 9-item Patient Health Questionnaire (PHQ-9) in 231 consecutive outpatients. The median follow-up time was 986 (IQR=664-1120) days.
The prevalence of suspected major depression was 13% (minor depression, 17%) and was not different between the sexes. Major (but not minor) depression was associated with an increased mortality risk (hazard ratio [HR]=3.3, 95% confidence interval=1.8-6.1, p<0.001). This relationship remained significant after adjustment for other prognostically relevant factors as age, sex, heart failure aetiology, degree and type of left ventricular dysfunction, and New York Heart Association functional class. However, testing the effect of the interaction between gender and depression failed to reach significance (p=0.37).
Our data confirm a high prevalence of depression in chronic heart failure. Further, they prove an independent prognostic impact of major, but not minor, depression. Possible gender differences regarding the prognostic impact of depression require further investigation in a larger patient cohort.
European Journal of Heart Failure 10/2007; 9(10):1018-23. · 4.90 Impact Factor
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ABSTRACT: Patients' health-related quality of life is increasingly being included as an additional endpoint when evaluating the treatment of chronic heart failure. Although generic self-report instruments measuring health-related quality of life are available, there is a lack of disease-specific instruments covering various dimensions of quality of life with high reliability, validity and sensitivity to chance. Thus, the aim of the present study was to evaluate the German version of a new heart failure-specific quality of life measure, the Kansas City Cardiomyopathy Questionnaire (KCCQ). The sample consisted of 233 consecutively recruited outpatients of a university department in Germany. Test-retest-reliability was high (intraclass correlation coefficient 0.93 for both the Functional State and the Clinical Summary total scores). Construct validity was demonstrated with strong correlations to respective subscales of the SF-36. Known groups validity was shown by both statistically and clinically significant differences between NYHA classes. The examination of sensitivity to change yielded promising results. The questionnaire was well accepted by the participating patients. The KCCQ proved to be a reliable and valid self-report instrument for measuring disease-specific quality of life in chronic heart failure.
PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie 55(3-4):200-8. · 1.02 Impact Factor
