title: Potentially modifiable correlates of functional status in patients with chronic heart failure.
abstract: BACKGROUND
  Chronic heart failure (CHF) patients suffer from multiple and agonizing symptoms like shortness of breath and reduced functional status, the latter of which is usually assessed using New York Heart Association (NYHA) functional class.
  
  
  OBJECTIVE
  In order to identify potentially modifiable factors of reduced functional status in patients with CHF, we investigated somatic and psychosocial correlates of NYHA functional class. We subsequently compared the results to correlates of left ventricular ejection fraction (LVEF) as an objective parameter of disease severity.
  
  
  METHODS
  The cross-sectional study (n = 314) was part of the German Heart Failure Network. Data were analysed using a logistic regression modelling process.
  
  
  RESULTS
  In the final regression model, NYHA functional class was only significantly associated with depression (odds ratio (OR) = 1.18; 95% confidence interval (CI) = 1.09-1.27) and multimorbidity (OR = 1.17; 95% CI = 1.04-1.32). LVEF was associated with amino-terminal pro-brain natriuretic peptide (NT-proBNP) (OR = 0.60; 95% CI = 0.44-0.82), aetiology of CHF (OR = 2.08; 95% CI = 1.11-3.90), and smoking (OR = 2.21; 95% CI = 1.25-3.91).
  
  
  CONCLUSIONS
  Whereas LVEF was not related to depression, our data revealed a close association between functional status (as assessed by NYHA functional class) and depression in patients with CHF, even after adjusting for cardiac and socio-demographic variables. Different forms of underlying causal mechanisms could be suspected; it appears promising to further investigate this specific interaction. In any event, pending further investigation, our results underscore the need to examine CHF patients with respect to both somatic symptom burden and potential depressive disorders.
authors.affiliation: Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany, Nicole_Lossnitzer@med.uni-heidelberg.de.
authors.forename: Nicole
authors.initials: N
authors.lastname: Lossnitzer
authors.forename: Beate
authors.initials: B
authors.lastname: Wild
authors.forename: Jobst-Hendrik
authors.initials: JH
authors.lastname: Schultz
authors.forename: Lutz
authors.initials: L
authors.lastname: Frankenstein
authors.forename: Markus
authors.initials: M
authors.lastname: Haass
authors.forename: Bernhard
authors.initials: B
authors.lastname: Rauch
authors.forename: Bernd
authors.initials: B
authors.lastname: Löwe
authors.forename: Hugo
authors.initials: H
authors.lastname: Katus
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000145:classification / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult