title: Changes in Depressive Symptoms and Mortality in Patients With Heart Failure: Effects of Cognitive-Affective and Somatic Symptoms.
abstract: OBJECTIVE
  Depression is an independent predictor of adverse outcomes in patients with heart failure (HF). However, the effect of changes in cognitive-affective and somatic symptoms on mortality of HF patients is not known. The purpose of this study was to examine whether changes in cognitive-affective and somatic depressive symptoms over time were associated with mortality in HF.
  
  
  METHODS
  In this secondary analysis of data from the Rural Education to Improve Outcomes in Heart Failure clinical trial, we analyzed data from 457 HF patients (39% female, mean [standard deviation] age = 65.6 [12.8] years) who survived at least 1 year and repeated the Patient Health Questionnaire at 1 year. Cognitive-affective and somatic depression scores were calculated, respectively, based on published Patient Health Questionnaire factor models. Using Cox proportional hazards regression analyses, we evaluated the effect of changes in cognitive-affective and somatic symptoms from baseline to 1 year on cardiac and all-cause deaths.
  
  
  RESULTS
  Controlling for baseline depression scores and other patient characteristics, the change in somatic symptoms was associated with increased risk of cardiac death during the subsequent 1-year period (hazard ratio = 1.24, 95% confidence interval = 1.07-1.44, p = .005), but the change in cognitive-affective symptoms was not (hazard ratio = 0.94, 95% confidence interval = 0.81-1.08, p = .38). Similar results were found for all-cause mortality.
  
  
  CONCLUSIONS
  Worsening somatic depressive symptoms, not cognitive-affective symptoms, are independently associated with increased mortality of HF patients. The findings suggest that routine and ongoing assessment of somatic depressive symptoms in HF patients may help clinicians identify patients at increased risk for adverse outcomes.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00415545.
authors.affiliation: From the College of Nursing & Research Institute of Nursing Science (Hwang), Seoul National University, Seoul, Korea; College of Nursing (Moser), University of Kentucky, Lexington, Kentucky; School of Nursing (Pelter, Dracup), University of California, San Francisco, San Francisco, California; and School of Medicine (Nesbitt), University of California, Davis, Sacramento, California.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Hwang
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.forename: Michele M
authors.initials: MM
authors.lastname: Pelter
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Nesbitt
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dracup
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic