title: Depression as an independent prognostic factor for all-cause mortality after a hospital admission for worsening heart failure.
abstract: BACKGROUND
  Depression is associated with increased mortality amongst patients with chronic heart failure (HF). Whether depression is an independent predictor of outcome in patients admitted for worsening of HF is unclear.
  
  
  METHODS
  OPERA-HF is an observational study enrolling patients hospitalized with worsening HF. Depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D) questionnaire. Comorbidity was assessed by the Charlson Comorbidity Index (CCI). Kaplan-Meier and Cox regression analyses were used to estimate the association between depression and all-cause mortality.
  
  
  RESULTS
  Of 242 patients who completed the HADS-D questionnaire, 153, 54 and 35 patients had no (score 0-7), mild (score 8-10) or moderate-to-severe (score 11-21) depression, respectively. During follow-up, 35 patients died, with a median time follow-up of 360days amongst survivors (interquartile range, IQR 217-574days). In univariable analysis, moderate-to-severe depression was associated with an increased risk of death (HR: 4.9; 95% CI: 2.3 to 10.2; P<0.001) compared to no depression. Moderate-to-severe depression also predicted all-cause mortality after controlling for age, CCI score, NYHA class IV, NT-proBNP and treatment with mineralocorticoid receptor antagonist, beta-blocker and diuretics (HR: 3.0; 95% CI: 1.3 to 7.0; P<0.05).
  
  
  CONCLUSIONS
  Depression is strongly associated with an adverse outcome in the year following discharge after an admission to hospital for worsening HF. The association is only partly explained by the severity of HF or comorbidity. Further research is required to demonstrate whether recognition and treatment of depression improves patient outcomes.
authors.affiliation: Philips Research - Healthcare, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands; Department of Public Health, Centre for Medical Decision Making, Erasmus MC, Rotterdam, The Netherlands. Electronic address: ioanna.sokoreli@philips.com.
authors.forename: I
authors.initials: I
authors.lastname: Sokoreli
authors.affiliation: Philips Research - Healthcare, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands.
authors.forename: J J G
authors.initials: JJ
authors.lastname: de Vries
authors.affiliation: Philips Research - Healthcare, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Riistama
authors.affiliation: Philips Research - Healthcare, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands.
authors.forename: S C
authors.initials: SC
authors.lastname: Pauws
authors.affiliation: Department of Public Health, Centre for Medical Decision Making, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: E W
authors.initials: EW
authors.lastname: Steyerberg
authors.affiliation: Philips Research - Healthcare, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Tesanovic
authors.affiliation: Philips Research - Healthcare, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Geleijnse
authors.affiliation: University of Hull, Hull, UK.
authors.forename: K M
authors.initials: KM
authors.lastname: Goode
authors.affiliation: University of Hull, Hull, UK.
authors.forename: A
authors.initials: A
authors.lastname: Crundall-Goode
authors.affiliation: University of Hull, Hull, UK.
authors.forename: S
authors.initials: S
authors.lastname: Kazmi
authors.affiliation: University of Hull, Hull, UK; National Heart & Lung Institute, Imperial College, London, UK.
authors.forename: J G
authors.initials: JG
authors.lastname: Cleland
authors.affiliation: University of Hull, Hull, UK.
authors.forename: A L
authors.initials: AL
authors.lastname: Clark
mesh_terms: D000368:Aged; D003863:Depression / Q000175:diagnosis / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment; D013223:Statistics as Topic; D006113:United Kingdom / Q000453:epidemiology
keywords: Depression; Heart failure; Mortality; Risk factor