Depression worsens outcomes in elderly patients with heart failure: An analysis of 48,117 patients in a community setting

Aims: To assess the relationship between depression and clinical outcomes among elderly patients with heart failure (HF) in a community setting. Methods and results: To identify patients with HE and depression we used record linkage analysis of hospital discharge records, prescription databases and vital statistics. All consecutive patients aged >= 60 years in 6 Local Health Authorities in Italy were included. HE was defined as either: 1) hospital discharge with HF diagnosis (ICD-9: 428) and/or 2) chronic treatment for HE identified as concomitant (within 45 days) prescription of any combination of ACE inhibitors, digoxin, furosemide, bisoprolol, carvedilol, spironolactone, ARB-blockers. Depression was identified from exposure to psychotropic drugs before HE diagnosis. Cox proportional hazards models adjusted for major confounders were used. To adjust for potential residual known confounders, a propensity score analysis was performed. Sensitivity and subgroup analysis were used to demonstrate the consistency or robustness of the results. 48,117 patients with HE were identified. Of these, 3328 (6.9%) were treated for depression. Among patients with HE, those with depression were significantly older, and more likely to be women with a previous stroke. Depression significantly worsened major outcomes including all cause mortality [HR (95%CI); 1.20 (1.08-1.33)] and the composite of stroke/TIA/AMI [1.23 (1.13-1.34)]. Patients with depression had no increased risk of rehospitalisation for HE. Propensity scores and subgroup analysis confirmed these findings. Conclusion: Among elderly patients with HE, depression was independently associated with poor clinical outcomes mostly due to an increase in vascular events. (c) 2008 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.