title: Depressive symptoms are common and associated with adverse clinical outcomes in heart failure with reduced and preserved ejection fraction.
abstract: BACKGROUND
  Little is known about depressive symptoms in heart failure with preserved ejection fraction (HFpEF, EF ≥50%). We aimed to assess the prevalence of depression, to clarify the impact of depressive symptoms upon clinical outcomes, and to identify factors associated with these symptoms in HF with reduced EF (HFrEF, EF <50%) and HFpEF.
  
  
  RESULTS
  A total of 106 HF outpatients were enrolled. Of them, 61 (58%) had HFpEF. Most patients were male (HFrEF 80%, HFpEF 70%) and the mean of plasma B-type natriuretic peptide (BNP) level in the HFrEF group was similar to that in the HFpEF group (164.8 ± 232.8 vs. 98.7 ± 94.8 pg/mL). HFrEF patients were treated more frequently with beta-blockers compared with HFpEF patients (71% vs. 43%, p=0.004). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). The prevalence of depression (CES-D score ≥16), and CES-D score did not significantly differ between HFrEF and HFpEF (24% vs. 25%, 14.1 ± 8.3 vs. 12.1 ± 8.3, respectively). During the 2-year follow-up, depressed patients had more cardiac death or HF hospitalization in HFrEF (55% vs. 12%, p=0.002) and HFpEF (35% vs. 11%, p=0.031). Cox proportional hazard analysis revealed that a higher CES-D score, indicating increased depressive symptoms, predicted cardiac events independent of BNP in HFrEF [hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.01-1.13] and HFpEF (HR 1.09, 95% CI 1.04-1.15). Multiple regression analyses adjusted for BNP showed that independent predictors of depressive symptoms were non-usage of beta-blockers and being widowed or divorced in HFrEF. On the other hand, usage of warfarin was the only independent risk factor for depressive symptoms in HFpEF (all, p<0.05).
  
  
  CONCLUSIONS
  Depressive symptoms are common and independently predict adverse events in HFrEF/HFpEF patients. This study suggests that beta-blockers reduce depressive symptoms in HFrEF. In contrast, treatment for depression remains to be elucidated in HFpEF.
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan. naokat-tky@umin.ac.jp
authors.forename: Naoko
authors.initials: N
authors.lastname: Kato
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Taro
authors.initials: T
authors.lastname: Shiga
authors.forename: Masaru
authors.initials: M
authors.lastname: Hatano
authors.forename: Norihiko
authors.initials: N
authors.lastname: Takeda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Imai
authors.forename: Masafumi
authors.initials: M
authors.lastname: Watanabe
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yao
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Hirata
authors.forename: Keiko
authors.initials: K
authors.lastname: Kazuma
authors.forename: Ryozo
authors.initials: R
authors.lastname: Nagai
mesh_terms: D000368:Aged; D003863:Depression / Q000209:etiology*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology*
chemical_list: D020097:Natriuretic Peptide, Brain