title: Relationship between depressive symptoms and long-term mortality in patients with heart failure.
abstract: BACKGROUND
  Depression is prevalent in patients with heart failure (HF) and is associated with short-term poor prognosis. However, the long-term effect of depression and the use of self-administered depression evaluation on HF prognosis remained unknown. The study sought to assess the association of depressive symptoms and long-term mortality of patients with HF and to explore the prognostic predictability of the Beck Depression Inventory (BDI) scale for patients with HF.
  
  
  METHODS
  Hospitalized patients with HF between March 1997 and June 2003 were recruited. All participants were given the self-administered BDI scale for depression assessment during the index admission. They were then followed for 6 months for the collection of vital status, and annually thereafter.
  
  
  RESULTS
  Total study population comprises 1006 patients. The mean BDI score was 8.3 +/- 7.1. The average days of follow-up were 971 +/- 730 and the vital status was obtained from all participants. During this period, 42.6% of the participants died. Depression (defined by BDI score > or = 10) was significantly and independently associated with reduced survival (adjusted hazard ratio 1.36, 95% CI 1.09-1.70, P < .001). Patients whose BDI scores were 5 to 9, 10 to 18, and > or = 19 were 21%, 53%, and 83% more likely to die, respectively, than patients whose BDI score was < 5 (P < .001).
  
  
  CONCLUSIONS
  Self-rated depression by BDI is independently linked with higher long-term mortality in patients with HF. Significant dose effect of depressive symptoms on higher mortality is noted.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. jiang001@mc.duke.edu
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.forename: Maragatha
authors.initials: M
authors.lastname: Kuchibhatla
authors.forename: Greg L
authors.initials: GL
authors.lastname: Clary
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cuffe
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Christopher
authors.forename: Jude D
authors.initials: JD
authors.lastname: Alexander
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Ranga R
authors.initials: RR
authors.lastname: Krishnan
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
mesh_terms: D017677:Age Distribution; D000368:Aged; D015897:Comorbidity; D003863:Depression / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009657:North Carolina / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012372:ROC Curve; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis