title: Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure.
abstract: OBJECTIVE
  The purpose of this study was to assess whether depressive symptoms are independently associated with changes in heart failure (HF)-specific health status.
  
  
  BACKGROUND
  Depression is common in patients with HF, but the impact of depressive symptoms on the health status of these patients over time is unknown.
  
  
  METHODS
  We conducted a multicenter prospective cohort study of outpatients with HF. Data from 460 patients who completed a baseline Medical Outcomes Study-Depression Questionnaire and both a baseline and follow-up (6 +/- 2 weeks) Kansas City Cardiomyopathy Questionnaire (KCCQ) were analyzed. The KCCQ measures HF-specific health status, including symptoms, physical and social function, and quality of life. Multivariable regression was used to evaluate depressive symptoms as a predictor of change in KCCQ scores, adjusting for baseline KCCQ scores and other patient variables. The primary outcome was change in KCCQ summary scores (range 0 to 100; higher scores indicate better health status; 5 points is a clinically meaningful change).
  
  
  RESULTS
  Approximately 30% (139/460) of the patients had significant depressive symptoms at baseline. Depressed patients had markedly lower baseline KCCQ summary scores (beta = -19.6; p < 0.001). After adjustment for potential confounders, depressed patients were at risk for significant worsening of their HF symptoms, physical and social function, and quality of life (average change in KCCQ summary score = -7.1 points; p < 0.001). Depressive symptoms were the strongest predictor of decline in health status in the multivariable models.
  
  
  CONCLUSIONS
  Depressive symptoms are a strong predictor of short-term worsening of HF-specific health status. The recognition and treatment of depression may be an important component of HF care.
authors.affiliation: Cardiology (111B), Denver VA Medical Center, Denver, Colorado 80220, USA. John.Rumsfeld@med.va.gov
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.forename: Edward
authors.initials: E
authors.lastname: Havranek
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Philip
authors.initials: P
authors.lastname: Jones
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Tooley
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology*; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D013997:Time Factors