Heart failure patients who are moderately or severely depressed have four times the risk of dying and double the risk of having to go to the emergency room or be hospitalized compared to those who are not depressed, according to new research reported in Circulation: Heart Failure, an American Heart Association Journal.
"Depression is a key driver of healthcare use in heart failure," said Alanna M. Chamberlain, Ph.D., M.P.H., the study's lead author and assistant professor of epidemiology in the Department of Health Sciences Research at the Mayo Clinic in Rochester, Minn. "Treatment programs should be tailored to each patient's needs with greater emphasis on managing depression either through medication or lifestyle interventions."
In 2007-10, 402 heart failure patients (58 percent male, average age 73) in three Minnesota counties completed a nine-question survey. Based on the answers, 59 percent of patients were classified as having no depression, 26 percent had mild depression and 15 percent had moderate-to-severe depression. Researchers gathered information on the participants for about a year and a half.
Even those who reported mild depression had almost a 60 percent increased risk of death, but a much smaller increased risk of emergency room visits (35 percent) and hospitalizations (16 percent), researchers found.
Because the patients studied were mostly white and lived in southeastern Minnesota, the results may not apply to all heart failure patients throughout the United States, researchers said only a third of the patients with moderate-to-severe depression were taking antidepressant medication. Depression may be underdiagnosed in these patients; however, some may have been undergoing therapy that didn't include prescription drugs, researchers said.
"We measured depression with a one-time questionnaire so we cannot account for changes in depression symptoms over time," Chamberlain said. "Further research is warranted to develop more effective clinical approaches for management of depression in heart failure patients."
Co-authors are: Amanda R. Moraska, B.A.; Nilay D. Shah, Ph.D.; Kristin S. Vickers, Ph.D.; Teresa A. Rummans, M.D.; Shannon M. Dunlay, M.D., M.Sc.; John A. Spertus, M.D., M.P.H; Susan A. Weston, M.S.; Sheila M. McNallan, M.P.H.; Margaret M. Redfield, M.D.; and Veronique L. Roger, M.D., M.P.H.
The National Heart, Lung, and Blood Institute and the National Institute on Aging funded the study.
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