Depression linked to heart failure mortality increase

Chuck Bednar for redOrbit.com – @BednarChuck

Congestive heart failure patients who experience moderate to severe depression face a five-fold increased risk of all-cause mortality compared to those that do not suffer from the mood disorder, researchers from Imperial College London and the University of Hull have discovered.

The results were presented over the weekend at Heart Failure 2015, an annual meeting of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC), by John Cleland, a professor of cardiology at both universities and chief investigator of the OPERA-HF study.

Cleland and his colleagues found that patients who were not depressed had an 80-percent lower mortality risk, and that the risk was independent of the severity of heart failure and the other risk factors. OPERA-HF, the authors explained, set out to determine the reasons for hospital readmission and death in heart failure patients.

“Patients with heart failure are at high risk of recurrent hospital admissions and death,” Cleland said in a statement. “Approximately 25 percent of patients admitted to hospital with heart failure are readmitted for a variety of reasons within one month. Within one year, most patients will have had one or more readmissions and almost half will have died.”

Explaining the association between depression and mortality

With OPERA-HF, the professor’s team set out to holistically investigate the predictors of and the social, mental, and physical causes of this phenomenon. Depression had previously been reported to predict death in heart failure patients, but this link was believed to be due to more severe heart failure or more comorbidities in depressed patients, they said.

As part of the observational study, heart-failure patients were assessed for depression using the Hospital Anxiety and Depression Scale (HADS-D) questionnaire, and comorbidity was looked at using the Charlson Comorbidity Index (CCI). The researchers found that patients with moderate to severe depression had a five-fold increase of death versus those with mild to no depression.

“Our results show that depression is strongly associated with death during the year following discharge from hospital after an admission for the exacerbation of heart failure; we expect that the link persists beyond one year,” Professor Cleland said. “The association was independent of the severity of heart failure or the presence of comorbidities.”

“We know that depression is common in heart failure and affects 20- to 40-percent of patients,” he added. “Depression is often related to loss of motivation, loss of interest in everyday activities, lower quality of life, loss of confidence, sleep disturbances, and change in appetite with corresponding weight change. This could explain the association we found between depression and mortality.”

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