title: Depression and the delay between symptom onset and hospitalization in heart failure patients.
abstract: OBJECTIVE
  Heart failure (HF) patients frequently suffer from episodes of deterioration and may need medical treatment. An adequate reaction from the patient is needed to decrease the delay between the onset of deterioration and consulting a medical professional (i.e. consulting behaviour). The aim of the present study was to evaluate whether depressive symptoms are associated with the duration of the delay between the onset of symptoms of worsening HF and hospitalization, and to examine how consulting behaviour correlates to depressive symptoms and delay in HF patients.
  
  
  RESULTS
  Data on the time between the onset of symptoms of worsening HF and hospitalization, depressive symptoms, and self-care behaviour were collected in 958 HF patients (37% female; age 71 ± 11 years; New York Heart Association functional class II-IV), using validated questionnaires. The median delay time of the total sample was 72 h (ranging from 0 to 243 days). Patients with depressive symptoms delayed longer compared with those without depressive symptoms (120 vs. 54 h, P= 0.001). Patients with depressive symptoms had a 1.5 times higher risk for a delay of ≥ 72 h, independent of demographic and clinical variables (P= 0.008). Consulting behaviour did not correlate with depressive symptoms but was weakly associated with delay (r= -0.07, P= 0.03).
  
  
  CONCLUSIONS
  Heart failure patients with depressive symptoms have a significantly longer delay between HF deterioration and hospital admission. Interventions designed to improve the consulting behaviour in HF patients with depressive symptoms may have a limited effect on delay. Further research is needed to obtain more insight into the mechanisms underlying the relationship between delay and depression.
authors.affiliation: Department of Cardiology, Linköping University Hospital, SE-58185, Linköping, Sweden. peter.johansson@aries.vokby.se
authors.forename: Peter
authors.initials: P
authors.lastname: Johansson
authors.forename: Maurice
authors.initials: M
authors.lastname: Nieuwenhuis
authors.forename: Ivonne
authors.initials: I
authors.lastname: Lesman-Leegte
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D042241:Early Diagnosis; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors