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Medientyp:
E-Artikel
Titel:
Major Depression and Long-Term Survival of Patients With Heart Failure
Beteiligte:
Freedland, Kenneth E.;
Hesseler, Michael J.;
Carney, Robert M.;
Steinmeyer, Brian C.;
Skala, Judith A.;
Dávila-Román, Victor G.;
Rich, Michael W.
Beschreibung:
<jats:title>ABSTRACT</jats:title>
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<jats:title>Objectives</jats:title>
<jats:p>Previous studies have found that depression predicts all-cause mortality in heart failure (HF), but little is known about its effect on long-term survival. This study examined the effects of depression on long-term survival in patients with HF.</jats:p>
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<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>Patients hospitalized with HF (<jats:italic toggle="yes">n</jats:italic> = 662) at an urban academic medical center were enrolled in a prospective cohort study between January 1994 and July 1999. Depression was assessed on a structured interview during the index hospitalization and on quarterly interviews for 1 year after discharge. Patients were classified at index as having <jats:italic toggle="yes">Diagnostic and Statistical Manual, Fourth Edition</jats:italic> major depressive disorder (<jats:italic toggle="yes">n</jats:italic> = 131), minor depression (<jats:italic toggle="yes">n</jats:italic> = 106), or no depression (<jats:italic toggle="yes">n</jats:italic> = 425). Clinical data and the National Death Index were used to identify date of death or last known contact through December 19, 2014, up to 20 years after the index hospitalization. The main outcome was time from enrollment to death from any cause.</jats:p>
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<jats:sec>
<jats:title>Results</jats:title>
<jats:p>A total of 617 (94.1%) patients died during the follow-up period. Major depressive disorder was associated with higher all-cause mortality compared with no depression (adjusted hazard ratio = 1.64, 95% confidence interval = 1.27–2.11, <jats:italic toggle="yes">p</jats:italic> = .0001). This association was stronger than that of any of the established predictors of mortality that were included in the fully adjusted model. Patients with persistent or worsening depressive symptoms during the year after discharge were at greatest risk for death. The association between minor depression and survival was not significant.</jats:p>
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<jats:title>Conclusions</jats:title>
<jats:p>Major depression is an independent risk factor for all-cause mortality in patients with HF. Its effect persists for many years after the diagnosis of depression.</jats:p>
</jats:sec>