Depression as an independent prognostic factor for all-cause mortality after a hospital admission for worsening heart failure

I Sokoreli, J J G de Vries, J M Riistama, S C Pauws, E W Steyerberg, A Tesanovic, G Geleijnse, K M Goode, A Crundall-Goode, S Kazmi, J G Cleland, A L Clark

Research output: Contribution to journalArticleScientificpeer-review

Abstract

BACKGROUND: Depression is associated with increased mortality amongst patients with chronic heart failure (HF). Whether depression is an independent predictor of outcome in patients admitted for worsening of HF is unclear.

METHODS: OPERA-HF is an observational study enrolling patients hospitalized with worsening HF. Depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D) questionnaire. Comorbidity was assessed by the Charlson Comorbidity Index (CCI). Kaplan-Meier and Cox regression analyses were used to estimate the association between depression and all-cause mortality.

RESULTS: Of 242 patients who completed the HADS-D questionnaire, 153, 54 and 35 patients had no (score 0-7), mild (score 8-10) or moderate-to-severe (score 11-21) depression, respectively. During follow-up, 35 patients died, with a median time follow-up of 360days amongst survivors (interquartile range, IQR 217-574days). In univariable analysis, moderate-to-severe depression was associated with an increased risk of death (HR: 4.9; 95% CI: 2.3 to 10.2; P<0.001) compared to no depression. Moderate-to-severe depression also predicted all-cause mortality after controlling for age, CCI score, NYHA class IV, NT-proBNP and treatment with mineralocorticoid receptor antagonist, beta-blocker and diuretics (HR: 3.0; 95% CI: 1.3 to 7.0; P<0.05).

CONCLUSIONS: Depression is strongly associated with an adverse outcome in the year following discharge after an admission to hospital for worsening HF. The association is only partly explained by the severity of HF or comorbidity. Further research is required to demonstrate whether recognition and treatment of depression improves patient outcomes.

Original languageEnglish
Pages (from-to)202-7
Number of pages6
JournalInternational Journal of Cardiology
Volume220
DOIs
Publication statusPublished - 2016

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Depression
Comorbidity
Survivors

Keywords

  • Aged
  • Depression
  • Disease Progression
  • Female
  • Heart Failure
  • Hospitalization
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Mortality
  • Prognosis
  • Proportional Hazards Models
  • Psychiatric Status Rating Scales
  • Risk Assessment
  • Statistics as Topic
  • United Kingdom
  • Journal Article
  • Observational Study

Cite this

Sokoreli, I ; de Vries, J J G ; Riistama, J M ; Pauws, S C ; Steyerberg, E W ; Tesanovic, A ; Geleijnse, G ; Goode, K M ; Crundall-Goode, A ; Kazmi, S ; Cleland, J G ; Clark, A L. / Depression as an independent prognostic factor for all-cause mortality after a hospital admission for worsening heart failure. In: International Journal of Cardiology. 2016 ; Vol. 220. pp. 202-7.
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title = "Depression as an independent prognostic factor for all-cause mortality after a hospital admission for worsening heart failure",
abstract = "BACKGROUND: Depression is associated with increased mortality amongst patients with chronic heart failure (HF). Whether depression is an independent predictor of outcome in patients admitted for worsening of HF is unclear.METHODS: OPERA-HF is an observational study enrolling patients hospitalized with worsening HF. Depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D) questionnaire. Comorbidity was assessed by the Charlson Comorbidity Index (CCI). Kaplan-Meier and Cox regression analyses were used to estimate the association between depression and all-cause mortality.RESULTS: Of 242 patients who completed the HADS-D questionnaire, 153, 54 and 35 patients had no (score 0-7), mild (score 8-10) or moderate-to-severe (score 11-21) depression, respectively. During follow-up, 35 patients died, with a median time follow-up of 360days amongst survivors (interquartile range, IQR 217-574days). In univariable analysis, moderate-to-severe depression was associated with an increased risk of death (HR: 4.9; 95{\%} CI: 2.3 to 10.2; P<0.001) compared to no depression. Moderate-to-severe depression also predicted all-cause mortality after controlling for age, CCI score, NYHA class IV, NT-proBNP and treatment with mineralocorticoid receptor antagonist, beta-blocker and diuretics (HR: 3.0; 95{\%} CI: 1.3 to 7.0; P<0.05).CONCLUSIONS: Depression is strongly associated with an adverse outcome in the year following discharge after an admission to hospital for worsening HF. The association is only partly explained by the severity of HF or comorbidity. Further research is required to demonstrate whether recognition and treatment of depression improves patient outcomes.",
keywords = "Aged, Depression, Disease Progression, Female, Heart Failure, Hospitalization, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Mortality, Prognosis, Proportional Hazards Models, Psychiatric Status Rating Scales, Risk Assessment, Statistics as Topic, United Kingdom, Journal Article, Observational Study",
author = "I Sokoreli and {de Vries}, {J J G} and Riistama, {J M} and Pauws, {S C} and Steyerberg, {E W} and A Tesanovic and G Geleijnse and Goode, {K M} and A Crundall-Goode and S Kazmi and Cleland, {J G} and Clark, {A L}",
note = "Copyright {\circledC} 2016 Elsevier Ireland Ltd. All rights reserved.",
year = "2016",
doi = "10.1016/j.ijcard.2016.06.068",
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pages = "202--7",
journal = "International Journal of Cardiology",
issn = "0167-5273",
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Sokoreli, I, de Vries, JJG, Riistama, JM, Pauws, SC, Steyerberg, EW, Tesanovic, A, Geleijnse, G, Goode, KM, Crundall-Goode, A, Kazmi, S, Cleland, JG & Clark, AL 2016, 'Depression as an independent prognostic factor for all-cause mortality after a hospital admission for worsening heart failure', International Journal of Cardiology, vol. 220, pp. 202-7. https://doi.org/10.1016/j.ijcard.2016.06.068

Depression as an independent prognostic factor for all-cause mortality after a hospital admission for worsening heart failure. / Sokoreli, I; de Vries, J J G; Riistama, J M; Pauws, S C; Steyerberg, E W; Tesanovic, A; Geleijnse, G; Goode, K M; Crundall-Goode, A; Kazmi, S; Cleland, J G; Clark, A L.

In: International Journal of Cardiology, Vol. 220, 2016, p. 202-7.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Depression as an independent prognostic factor for all-cause mortality after a hospital admission for worsening heart failure

AU - Sokoreli, I

AU - de Vries, J J G

AU - Riistama, J M

AU - Pauws, S C

AU - Steyerberg, E W

AU - Tesanovic, A

AU - Geleijnse, G

AU - Goode, K M

AU - Crundall-Goode, A

AU - Kazmi, S

AU - Cleland, J G

AU - Clark, A L

N1 - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PY - 2016

Y1 - 2016

N2 - BACKGROUND: Depression is associated with increased mortality amongst patients with chronic heart failure (HF). Whether depression is an independent predictor of outcome in patients admitted for worsening of HF is unclear.METHODS: OPERA-HF is an observational study enrolling patients hospitalized with worsening HF. Depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D) questionnaire. Comorbidity was assessed by the Charlson Comorbidity Index (CCI). Kaplan-Meier and Cox regression analyses were used to estimate the association between depression and all-cause mortality.RESULTS: Of 242 patients who completed the HADS-D questionnaire, 153, 54 and 35 patients had no (score 0-7), mild (score 8-10) or moderate-to-severe (score 11-21) depression, respectively. During follow-up, 35 patients died, with a median time follow-up of 360days amongst survivors (interquartile range, IQR 217-574days). In univariable analysis, moderate-to-severe depression was associated with an increased risk of death (HR: 4.9; 95% CI: 2.3 to 10.2; P<0.001) compared to no depression. Moderate-to-severe depression also predicted all-cause mortality after controlling for age, CCI score, NYHA class IV, NT-proBNP and treatment with mineralocorticoid receptor antagonist, beta-blocker and diuretics (HR: 3.0; 95% CI: 1.3 to 7.0; P<0.05).CONCLUSIONS: Depression is strongly associated with an adverse outcome in the year following discharge after an admission to hospital for worsening HF. The association is only partly explained by the severity of HF or comorbidity. Further research is required to demonstrate whether recognition and treatment of depression improves patient outcomes.

AB - BACKGROUND: Depression is associated with increased mortality amongst patients with chronic heart failure (HF). Whether depression is an independent predictor of outcome in patients admitted for worsening of HF is unclear.METHODS: OPERA-HF is an observational study enrolling patients hospitalized with worsening HF. Depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D) questionnaire. Comorbidity was assessed by the Charlson Comorbidity Index (CCI). Kaplan-Meier and Cox regression analyses were used to estimate the association between depression and all-cause mortality.RESULTS: Of 242 patients who completed the HADS-D questionnaire, 153, 54 and 35 patients had no (score 0-7), mild (score 8-10) or moderate-to-severe (score 11-21) depression, respectively. During follow-up, 35 patients died, with a median time follow-up of 360days amongst survivors (interquartile range, IQR 217-574days). In univariable analysis, moderate-to-severe depression was associated with an increased risk of death (HR: 4.9; 95% CI: 2.3 to 10.2; P<0.001) compared to no depression. Moderate-to-severe depression also predicted all-cause mortality after controlling for age, CCI score, NYHA class IV, NT-proBNP and treatment with mineralocorticoid receptor antagonist, beta-blocker and diuretics (HR: 3.0; 95% CI: 1.3 to 7.0; P<0.05).CONCLUSIONS: Depression is strongly associated with an adverse outcome in the year following discharge after an admission to hospital for worsening HF. The association is only partly explained by the severity of HF or comorbidity. Further research is required to demonstrate whether recognition and treatment of depression improves patient outcomes.

KW - Aged

KW - Depression

KW - Disease Progression

KW - Female

KW - Heart Failure

KW - Hospitalization

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Mortality

KW - Prognosis

KW - Proportional Hazards Models

KW - Psychiatric Status Rating Scales

KW - Risk Assessment

KW - Statistics as Topic

KW - United Kingdom

KW - Journal Article

KW - Observational Study

U2 - 10.1016/j.ijcard.2016.06.068

DO - 10.1016/j.ijcard.2016.06.068

M3 - Article

VL - 220

SP - 202

EP - 207

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -