title: The association of comorbid diabetes mellitus and symptoms of depression with all-cause mortality and cardiac rehospitalization in patients with heart failure.
abstract: BACKGROUND
  More than 22% of individuals with diabetes mellitus have concomitant heart failure (HF), and the prevalence of diabetes in those with HF is nearly triple that of individuals without HF. Comorbid depressive symptoms are common in diabetes and HF. Depressive symptoms are an independent predictor of mortality in individuals with diabetes alone, as well as those with HF alone and are a predictor of rehospitalization in those with HF. However, the association of comorbid HF, diabetes and depressive symptoms with all-cause mortality and rehospitalization for cardiac causes has not been determined.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the association of comorbid HF, diabetes and depression with all-cause mortality and rehospitalization for cardiac cause.
  
  
  METHODS
  Patients provided data at baseline about demographic and clinical variables and depressive symptoms; patients were followed for at least 2 years. Participants were divided into four groups based on the presence and absence of diabetes and depressive symptoms. Cox regression analysis was used to determine whether comorbid diabetes and depressive symptoms independently predicted all-cause mortality and cardiac rehospitalization in these patients with HF.
  
  
  RESULTS
  Patients (n=663) were primarily male (69%), white (76%), and aged 61±13 years. All-cause mortality was independently predicted by the presence of concomitant diabetes and depressive symptoms (HR 3.71; 95% CI 1.49 to 9.25; p=0.005), and depressive symptoms alone (HR 2.29; 95% CI 0.94 to 5.40; p=0.05). The presence of comorbid diabetes and depressive symptoms was also an independent predictor of cardiac rehospitalization (HR 2.36; 95% CI 1.27 to 4.39; p=0.007).
  
  
  CONCLUSIONS
  Comorbid diabetes and depressive symptoms are associated with poorer survival and rehospitalization in patients with HF; effective strategies to regularly evaluate and effectively manage these comorbid conditions are necessary to improve survival and reduce rehospitalization rates.
authors.affiliation: Vanderbilt University , Tennessee , USA.
authors.forename: Geri C
authors.initials: GC
authors.lastname: Reeves
authors.affiliation: University of Kentucky , Lexington , USA ; The University of Jordan , Amman , Jordan.
authors.forename: Abdullah S
authors.identifier: 0000-0003-2788-3010
authors.initials: AS
authors.lastname: Alhurani
authors.affiliation: University of Kentucky , Lexington , USA.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Frazier
authors.affiliation: University of Kentucky , Lexington , USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Watkins
authors.affiliation: University of Kentucky , Lexington , USA.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
authors.affiliation: University of Kentucky , Lexington , USA ; The University of Ulster , Newtownabbey , UK.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
keywords: Heart Failure; Mortality; Type 1; Type 2 Diabetes