Depression increasingly predicts mortality in the course of congestive heart failure.
BACKGROUND
Congestive heart failure (CHF) is frequently associated with depression. However, the impact of depression on prognosis has not yet been sufficiently established.


OBJECTIVE
To prospectively investigate the influence of depression on mortality in patients with CHF.


METHODS
In 209 CHF patients depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D).


RESULTS
Compared to survivors (n=164), non-survivors (n=45) were characterized by a higher New York Heart Association (NYHA) functional class (2.8+/-0.7 vs. 2.5+/-0.6), and a lower left ventricular ejection fraction (LVEF) (18+/-8 vs. 23+/-10%) and peakVO(2) (13.1+/-4.5 vs. 15.4+/-5.2 ml/kg/min) at baseline. Furthermore, non-survivors had a higher depression score (7.5+/-4.0 vs. 6.1+/-4.3) (all P<0.05). After a mean follow-up of 24.8 months the depression score was identified as a significant indicator of mortality (P<0.01). In multivariate analysis the depression score predicted mortality independent from NYHA functional class, LVEF and peakVO(2). Combination of depression score, LVEF and peakVO(2) allowed for a better risk stratification than combination of LVEF and peakVO(2) alone. The risk ratio for mortality in patients with an elevated depression score (i.e. above the median) rose over time to 8.2 after 30 months (CI 2.62-25.84).


CONCLUSIONS
The depression score predicts mortality independent of somatic parameters in CHF patients not treated for depression. Its prognostic power increases over time and should, thus, be accounted for in risk stratification and therapy.
Jünger
Jana
J
Department of General Internal and Psychosomatic Medicine, University of Heidelberg, INF 410, D-69120 Heidelberg, Germany. Jana_Juenger@med.uni-heidelberg.de
Schellberg
Dieter
D
Müller-Tasch
Thomas
T
Raupp
Georg
G
Zugck
Christian
C
Haunstetter
Armin
A
Zipfel
Stephan
S
Herzog
Wolfgang
W
Haass
Markus
M
D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000209:etiology*; D003866:Depressive Disorder / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D015996:Survival Rate