title: Symptoms, depression, and quality of life in patients with heart failure.
abstract: BACKGROUND
  Little is known about symptoms and their burden in outpatients with chronic heart failure. Diverse symptoms may be associated with poor heart failure-related quality of life, and depression may be related to increased symptoms.
  
  
  RESULTS
  The number of symptoms and symptom distress (physical symptoms on the Memorial Symptom Assessment Scale-Short Form), depression (Geriatric Depression Scale-Short Form), and heart failure-related quality of life (Kansas City Cardiomyopathy Questionnaire) were measured cross-sectionally in 60 patients with heart failure from two outpatient cardiology clinics. Patients experienced a mean of nine symptoms in the previous week. More than half reported shortness of breath, lack of energy, pain, feeling drowsy, or dry mouth. In unadjusted analyses, more severe depression was associated with a greater number of symptoms (r = 0.51, P < .0001) and greater overall symptom distress (r = 0.58, P < .0001). For each additional depression symptom, the number of symptoms reported increased by 0.6 after adjustment for age, race, and N-terminal pro-brain natriuretic peptide (P = .01). The number of symptoms accounted for 32% of the variance in quality of life (P < .0001).
  
  
  CONCLUSIONS
  Patients with heart failure report a large number of distressing symptoms. Depression in patients with heart failure is associated with a greater number of symptoms, which in turn is associated with a decrease in heart failure-related quality of life. Treatment of depression and the diverse symptoms reported by patients with heart failure might significantly improve quality of life.
authors.affiliation: Department of Medicine, Division of General Internal Medicine, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Bekelman
authors.forename: Edward P
authors.initials: EP
authors.lastname: Havranek
authors.forename: Diane M
authors.initials: DM
authors.lastname: Becker
authors.forename: Jean S
authors.initials: JS
authors.lastname: Kutner
authors.forename: Pamela N
authors.initials: PN
authors.lastname: Peterson
authors.forename: Ilan S
authors.initials: IS
authors.lastname: Wittstein
authors.forename: Sheldon H
authors.initials: SH
authors.lastname: Gottlieb
authors.forename: Traci E
authors.initials: TE
authors.lastname: Yamashita
authors.forename: Diane L
authors.initials: DL
authors.lastname: Fairclough
authors.forename: Sydney M
authors.initials: SM
authors.lastname: Dy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000523:psychology*; D006801:Humans; D008297:Male; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires