title: The Impact of Body Mass Index on the Link Between Depressive Symptoms and Health Outcome in Patients With Heart Failure.
abstract: BACKGROUND
  Depressive symptoms are predictors of shorter cardiac event-free survival, whereas increased body mass index (BMI) is associated with longer cardiac event-free survival in patients with heart failure (HF). However, the impact of BMI on the link between depressive symptoms and cardiac event-free survival is unexplored. The purpose of this study was to determine whether the relationship between depressive symptoms and cardiac event-free survival differs among HF patients stratified by BMI tertiles.
  
  
  METHODS
  A total of 297 outpatients with HF completed the Patient Health Questionnaire-9 to assess depressive symptoms. Body mass index was calculated as weight in kilograms divided by height in meters squared. Patients were followed for 1 year to determine cardiac event-free survival. Cox proportional hazard regression with survival curves was used to determine the relationships among depressive symptoms, BMI, and cardiac event-free survival.
  
  
  RESULTS
  Both depressive symptoms (P < .001) and lower BMI (P = .002) are independent predictors of shorter cardiac event-free survival after controlling for age, gender, etiology, total comorbidity scores, ejection fraction, New York Heart Association functional class, and prescribed medications. Patients with depressive symptoms had shorter cardiac event-free survival compared with patients without depressive symptoms in the lowest (P = .001) and middle (P = .036) BMI tertiles. There was no difference in cardiac event-free survival between patients with and without depressive symptoms in the highest tertile (P = .894).
  
  
  CONCLUSIONS
  Higher BMI has a protective role in the adverse effect of depressive symptoms on health outcomes in patients with HF.
authors.affiliation: Eun Kyeung Song, PhD, RN Associate Professor, Department of Nursing, College of Medicine, University of Ulsan, South Korea. Debra K. Moser, DNSc, RN, FAAN Professor, College of Nursing, University of Kentucky, Lexington. Rebecca L. Dekker, PhD, APRN Assistant Professor, College of Nursing, University of Kentucky, Lexington. Terry A. Lennie, PhD, RN, FAAN Professor and Associate Dean, PhD Studies, College of Nursing, University of Kentucky, Lexington.
authors.forename: Eun Kyeung
authors.initials: EK
authors.lastname: Song
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Dekker
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003863:Depression / Q000453:epidemiology*; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011795:Surveys and Questionnaires