title: Depressive symptoms affect the relationship of N-terminal pro B-type natriuretic peptide to cardiac event-free survival in patients with heart failure.
abstract: BACKGROUND
  Both N-terminal pro B-type natriuretic peptide (NT-pro BNP) and depressive symptoms independently predict cardiac events in heart failure (HF) patients. However, the relationship among NT-pro BNP, depressive symptoms, and cardiac event is unknown.
  
  
  RESULTS
  Blood was drawn to measure NT-pro BNP and depressive symptoms were measured by the Patient Health Questionnaire 9 (PHQ-9) among 210 patients with HF. Data about cardiac event-free survival were collected for the average follow-up period of 397 days. Cox proportional hazards regression with survival curves were used to determine the relationship of NT-pro BNP and depressive symptoms to cardiac event-free survival. Higher NT-pro-BNP confers greater risk of cardiac events among those with depressive symptoms than those without depressive symptoms (P for the interaction = .029). Patients with NT-pro BNP > 581 pg/mL and total PHQ-9 score >/= 10 had a 5.5 times higher risk for cardiac events compared with patients with NT-pro BNP </= 581 pg/mL and total PHQ-9 score < 10 (P = .001).
  
  
  CONCLUSIONS
  The prognostic association of NT-pro BNP with cardiac event-free survival in patients with HF differed by the presence of depressive symptoms. Monitoring and treatment of depressive symptoms may be important for improving cardiac event-free survival in patients with HF.
authors.affiliation: Department of Nursing, University of Ulsan, Ulsan, Republic of Korea. gracesong@ulsan.ac.kr
authors.forename: Eun Kyeung
authors.initials: EK
authors.lastname: Song
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.forename: Susan K
authors.initials: SK
authors.lastname: Frazier
authors.forename: Seongkum
authors.initials: S
authors.lastname: Heo
authors.forename: Misook L
authors.initials: ML
authors.lastname: Chung
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000378:metabolism* / Q000523:psychology* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000378:metabolism* / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000502:physiology*; D010446:Peptide Fragments / Q000502:physiology*; D011446:Prospective Studies; D011498:Protein Precursors / Q000502:physiology*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain