Depression worsens outcomes in elderly patients with heart failure: an analysis of 48,117 patients in a community setting.
OBJECTIVE
To assess the relationship between depression and clinical outcomes among elderly patients with heart failure (HF) in a community setting.


RESULTS
To identify patients with HF and depression we used record linkage analysis of hospital discharge records, prescription databases and vital statistics. All consecutive patients aged>or=60 years in 6 Local Health Authorities in Italy were included. HF was defined as either: 1) hospital discharge with HF diagnosis (ICD-9: 428) and/or 2) chronic treatment for HF identified as concomitant (within 45 days) prescription of any combination of ACE inhibitors, digoxin, furosemide, bisoprolol, carvedilol, spironolactone, ARB-blockers. Depression was identified from exposure to psychotropic drugs before HF diagnosis. Cox proportional hazards models adjusted for major confounders were used. To adjust for potential residual known confounders, a propensity score analysis was performed. Sensitivity and subgroup analysis were used to demonstrate the consistency or robustness of the results. 48,117 patients with HF were identified. Of these, 3328 (6.9%) were treated for depression. Among patients with HF, those with depression were significantly older, and more likely to be women with a previous stroke. Depression significantly worsened major outcomes including all cause mortality [HR (95%CI); 1.20 (1.08-1.33)] and the composite of stroke/TIA/AMI [1.23 (1.13-1.34)]. Patients with depression had no increased risk of rehospitalisation for HF. Propensity scores and subgroup analysis confirmed these findings.


CONCLUSIONS
Among elderly patients with HF, depression was independently associated with poor clinical outcomes mostly due to an increase in vascular events.
Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy.
Alejandro
A
Macchia
Simona
S
Monte
Fabio
F
Pellegrini
Marilena
M
Romero
Antonio
A
D'Ettorre
Luigi
L
Tavazzi
Gianni
G
Tognoni
Aldo P
AP
Maggioni
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000008:administration & dosage; D016009:Chi-Square Distribution; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D018709:Statistics, Nonparametric
D000928:Antidepressive Agents