Depressive symptoms and risk of functional decline and death in patients with heart failure

Objectives We sought to examine whether depressive symptoms are associated with poorer prognosis in patients with heart failure. Background Depression is an established risk factor for poor outcome in patients with coronary heart disease (CHD). Little is known of its role in patients with heart failure. Methods We prospectively followed 391 patients greater than or equal to 50 years of age who met criteria for decompensated heart failure on hospital admission. The outcome of the study was death or decline in activities of daily living (ADL) at six months, relative to baseline. Depressive symptoms were measured at baseline by means of the Geriatric Depression Scale, Short-Form, with 6 to 7 symptoms, 8 to 10 symptoms and greater than or equal to 11 symptoms indicating mild, moderate and severe levels of depressive symptoms, respectively. Results There was a strong and graded association between the severity of depressive symptoms at baseline and the rate of the combined end point of either functional decline or death at six months. After adjustment for demographic factors, medical history, baseline functional status and clinical severity, patients with greater than or equal to 11 depressive symptoms, compared with those with <6 depressive symptoms, had an 82% higher risk of either functional decline or death, whereas the intermediate levels of depressive symptoms showed intermediate risk (p = 0.003 for trend). A similar graded association was found for functional decline and death separately; however, after multivariate analysis, the association with mortality was less strong and no longer statistically significant. Conclusions An increasing number of depressive symptoms is a negative prognostic factor for patients with heart failure, just as it is for patients with CHD. (J Am Coll Cardiol 2001;38:199-205) (C) 2001 by the American College of Cardiology.