Depressive symptoms and outcomes in patients with heart failure: data from the COACH study.
OBJECTIVE
To study the prognostic value of depressive symptoms on heart failure (HF) readmission and mortality, in a large and clinically relevant population of hospitalized HF patients adjusted for disease severity by B-type natriuretic peptide (BNP) level.


RESULTS
We studied 958 patients enrolled after hospitalization for HF; 37% female; mean age 71 +/- 11 years; New York Heart Association class II (51%) or III/IV (49%). Left ventricular ejection fraction: 33% +/- 14%, and median BNP level: 454 pg/mL (75% CI, 195-876 pg/mL). In total, 377 patients (39%) had depressive symptoms [Centre for Epidemiological Studies Depression Scale (CES-D) score >or=16] and 200 (21%) had severe depressive symptoms (score >or=24). During 18 months of follow-up, 386 (40%) patients reached the primary endpoint of death or readmission for HF. In multivariate analyses, CES-D was significantly associated with the primary endpoint [hazard ratio (HR) 1.13, P = 0.02], and also with both individual components of the primary endpoint [HF readmission (HR 1.165, P = 0.02) and mortality (HR 1.169, P = 0.02)]. Patients with severe depressive symptoms had a >40% higher risk for HF readmission or death.


CONCLUSIONS
In patients with HF, depression is independently associated with poor outcomes. These findings highlight the need for continued exploration of whether improvements in depression lead to better cardiovascular outcomes. The study was registered at clinical trial (www.trialregister.nl): NCT 98675639.
Lesman-Leegte
Ivonne
I
Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. g.a.t.lesman-leegte@thorax.umcg.nl
van Veldhuisen
Dirk J
DJ
Hillege
Hans L
HL
Moser
Debra
D
Sanderman
Robbert
R
Jaarsma
Tiny
T
D000368:Aged; D003863:Depression / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000523:psychology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010359:Patient Readmission; D011379:Prognosis
D020097:Natriuretic Peptide, Brain