title: Depression and heart failure associated with clinical COPD questionnaire outcome in primary care COPD patients: a cross-sectional study.
abstract: BACKGROUND
  Improvement in health-related quality of life (HRQoL) is one of the main goals in treating chronic obstructive pulmonary disease (COPD). Impaired HRQoL in COPD is associated with increased morbidity and mortality, hospitalisations and burden on our health-care system. The Clinical COPD Questionnaire (CCQ) is a validated, reliable, short questionnaire for the evaluation of disease-specific HRQoL in patients with COPD in primary care.
  
  
  OBJECTIVE
  To investigate factors that might be associated with CCQ outcome in COPD in a primary care setting.
  
  
  METHODS
  In a population of COPD patients in primary care, multiple regression analyses were used to assess associations between CCQ outcome and depression, heart failure, FEV1% predicted, FEV1/FVC, age, sex, body mass index and current smoking.
  
  
  RESULTS
  Data from 341 patients (mean age 68.1±10.3, COPD GOLD class I-III) were used for analyses. Together, heart failure and depression explained 23% of the variance in CCQ total score (P<0.001, N=93). Heart failure was most strongly associated with CCQ functional score (27% explained variance, P<0.001, N=100), whereas depression was most strongly associated with CCQ mental score (22% explained variance, P<0.001, N=93).
  
  
  CONCLUSIONS
  CCQ outcomes are higher in COPD patients with heart failure and depression. These findings might imply that heart failure and depression affect HRQoL of patients with COPD, and thus emphasise the importance of a holistic approach of this complex disease, leading to a correct diagnosis of COPD and its comorbidities, to achieve better tailored treatment of chronic patients.
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Manon
authors.initials: M
authors.lastname: Urff
authors.affiliation: Department of Respiratory Medicine, Isala klinieken, Zwolle, The Netherlands.
authors.forename: Jan-Willem K
authors.initials: JW
authors.lastname: van den Berg
authors.affiliation: Department of Respiratory Medicine, Isala klinieken, Zwolle, The Netherlands.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Uil
authors.affiliation: Department of Public Health and Primary Care, LUMC, Leiden, The Netherlands.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Chavannes
authors.affiliation: 1] Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands [2] General practice De Hof van Blom, Hattem, The Netherlands.
authors.forename: Roger A M J
authors.initials: RA
authors.lastname: Damoiseaux
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications*; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000523:psychology*; D011788:Quality of Life; D011795:Surveys and Questionnaires