title: Depression increasingly predicts mortality in the course of congestive heart failure.
abstract: 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.
authors.affiliation: Department of General Internal and Psychosomatic Medicine, University of Heidelberg, INF 410, D-69120 Heidelberg, Germany. Jana_Juenger@med.uni-heidelberg.de
authors.forename: Jana
authors.initials: J
authors.lastname: Jünger
authors.forename: Dieter
authors.initials: D
authors.lastname: Schellberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller-Tasch
authors.forename: Georg
authors.initials: G
authors.lastname: Raupp
authors.forename: Christian
authors.initials: C
authors.lastname: Zugck
authors.forename: Armin
authors.initials: A
authors.lastname: Haunstetter
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
authors.forename: Markus
authors.initials: M
authors.lastname: Haass
mesh_terms: 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