Abstract 1122: Weight Loss is a Link Between Depressive Symptoms and Cardiac Event-Free Survival in Patients With Heart Failure
Background. Weight loss is an independent predictor of mortality and morbidity in patients with heart failure (HF). Depressive symptoms may be associated with weight loss and their possible relation could confer higher risk for cardiac events in patients with HF. However, the link of weight loss and depressive symptoms to cardiac event-free survival has not been examined.
Purpose. The purpose of this study was to determine the association of weight loss and depressive symptoms with cardiac event-free survival.
Methods. This was a prospective study of 243 consecutive HF patients (61% male, 61±14 years, 69% NYHA class III/IV, mean body mass index [BMI] 24.0±3.6 kg/m2) enrolled during an index hospitalization for HF exacerbation. Patients completed the Beck Depression Inventory to measure depressive symptoms at discharge. Body weight was measured at discharge and 6 months later. Weight loss was defined as weight loss of greater than 6% of body weight since discharge. Time to first event of cardiac rehospitalization and cardiac death was followed for one year after discharge by review of medical record. Hierarchical logistic and Cox hazard regressions were used to determine the relationship among weight loss, depressive symptoms, and cardiac event-free survival.
Results. Thirty-five patients (14.4%) experienced weight loss at 6-months after discharge. Depressive symptoms (odds ratio [OR]=1.07, 95% CI=1.02–1.11) independently predicted weight loss in hierarchical logistic regression after controlling for age, gender, BMI, NYHA class, HF etiology, ejection fraction, and total comorbidity scores. The risk of weight loss increased by 7% for each one unit increase in depressive symptoms (p=.003). Weight loss (hazard ratio [HR]=2.47, 95% CI=1.47– 4.17) and depressive symptoms (HR=1.05, 95% CI=1.03–1.08) remained independent predictors of cardiac event-free survival in hierarchical Cox hazard regression after adjusting for same risk factors. Patients with weight loss had a 2.5 times higher risk for cardiac events compared to patients without weight loss (p=.001).
Conclusion. These findings suggested that weight loss is one of the possible mechanisms by which depressive symptoms predict shorter cardiac event-free survival in patients with HF.