title: Comorbid Depression and Heart Failure: A Community Cohort Study.
abstract: OBJECTIVE
  To examine the association between depression and clinical outcomes in heart failure (HF) in a community cohort.
  
  
  METHODS
  HF patients in Minnesota, United States completed depression screening using the 9-item Patient Health Questionnaire (PHQ-9) between 1st Oct 2007 and 1st Dec 2011; patients with PHQ-9≥5 were labelled "depressed". We calculated the risk of death and first hospitalization within 2 years using Cox regression. Results were adjusted for 10 commonly used prognostic factors (age, sex, systolic blood pressure, estimated glomerular filtration rate, serum sodium, ejection fraction, blood urea nitrogen, brain natriuretic peptide, presence of diabetes and ischaemic aetiology). Area under the curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) compared depression as a predictor against the aforementioned factors.
  
  
  RESULTS
  425 patients (mean age 74, 57.6% males) were included in the study; 179 (42.1%) had PHQ-9≥5. The adjusted hazard ratio of death was 2.02 (95% CI 1.34-3.04) and of hospitalization was 1.42 (95% CI 1.13-1.80) for those with compared to those without depression. Adding depression to the models did not appreciably change the AUC but led to statistically significant improvements in both the IDI (p = 0.001 and p = 0.005 for death and hospitalization, respectively) and NRI (for death and hospitalization, 35% (p = 0.002) and 27% (p = 0.007) were reclassified correctly, respectively).
  
  
  CONCLUSIONS
  Depression is frequent among community patients with HF and associated with increased risk of hospitalizations and death. Risk prediction for death and hospitalizations in HF patients can be improved by considering depression.
authors.affiliation: General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Bhautesh Dinesh
authors.identifier: http://orcid.org/0000-0001-7348-514X
authors.initials: BD
authors.lastname: Jani
authors.affiliation: General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Frances S
authors.initials: FS
authors.lastname: Mair
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America.|Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Véronique L
authors.initials: VL
authors.lastname: Roger
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Weston
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Ruoxiang
authors.initials: R
authors.lastname: Jiang
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Alanna M
authors.initials: AM
authors.lastname: Chamberlain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis