title: Somatic correlates of comorbid major depression in patients with systolic heart failure.
abstract: BACKGROUND
  Major depression is 4-5 times more common in heart failure than in the general population, and associated with adverse outcomes. This prospective study investigated somatic correlates of comorbid depression in patients with heart failure aiming to better understand the interrelation of both conditions.
  
  
  METHODS
  We enrolled 702 consecutive patients hospitalized for heart failure with a left ventricular ejection fraction (LVEF) ≤ 40% (mean age 67 years, 71% male). Suspected episodes of depression were identified using the Patient Health Questionnaire (PHQ-9). A score >11 (9-11) was defined as suspected major (minor) depression.
  
  
  RESULTS
  The prevalence of major (minor) depression was 24% (15%). Major depression was more common in women (30%) than men (22%, p = 0.02). In multivariable analysis, history of depression, (OR 3.09, 95%CI 1.98-4.82, p < 0.001), New York Heart Association class (OR 2.07 per class, 95%CI 1.52-2.81, p<0.001), leukocyte count >8000/mm(3) (OR 1.50, 95%CI 1.03-2.17, p = 0.032), and obstructive pulmonary disease (OR 1.61, 95%CI 1.04-2.50, p = 0.033) correlated independently with higher prevalence rates of major depression. Hemoglobin (OR 0.87 per g/dL, 95%CI 0.79-0.96, p = 0.005), and treatment with 3-hydroxy-3-methylglutaryl-coenzyme-A-reductase inhibitors (OR 0.66, 95%CI 0.45-0.98, p = 0.039) correlated independently with lower prevalence rates. Female sex, diabetes, peripheral edema, hyperuricemia, cholesterol <150 mg/dL, LVEF <30%, peripheral vascular disease, diuretics, and renal dysfunction were predictive only in univariable models.
  
  
  CONCLUSIONS
  The high prevalence of major depression in patients with heart failure seems closely linked to various typical clinical features of this syndrome. Whether this implicates differential therapeutic needs in patients with comorbid compared with primary depression requires further investigation.
authors.affiliation: University of Würzburg, Department of Internal Medicine I/Center for Cardiovascular Medicine, Würzburg, Germany.
authors.forename: Christiane E
authors.initials: CE
authors.lastname: Angermann
authors.forename: Götz
authors.initials: G
authors.lastname: Gelbrich
authors.forename: Stefan
authors.initials: S
authors.lastname: Störk
authors.forename: Marion
authors.initials: M
authors.lastname: Schowalter
authors.forename: Jürgen
authors.initials: J
authors.lastname: Deckert
authors.forename: Georg
authors.initials: G
authors.lastname: Ertl
authors.forename: Hermann
authors.initials: H
authors.lastname: Faller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D054143:Heart Failure, Systolic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors