Abstract 15988: Worsening Somatic Depressive Symptoms Are Associated With Increased Mortality in Patients With Heart Failure
Background: Depression is prevalent in patients with heart failure (HF) and is associated with poor prognosis. However, the effect of changes in specific symptoms over time on mortality of HF patients is not known.
Objective: To examine whether changes in cognitive and somatic symptoms of depression over time predict mortality of HF patients.
Methods: In this secondary analysis of data from the REMOTE-HF clinical trial, we analyzed data from 451 HF patients who survived at least 1 year and completed the 9-item Patient Health Questionnaire (PHQ-9) at 1 year (40% female, age 65.7 ± 12.8 years, ejection fraction [EF] = 39.0 ± 15.1%, 87.3% NYHA class II or III). Depressive symptoms were assessed with the PHQ-9 at baseline and at 1 year. Based on published PHQ-9 factor models, cognitive and somatic scores were calculated, respectively. Medical records were reviewed for clinical data. Controlling for baseline depressive symptoms and demographic and clinical characteristics, Cox proportional-hazards regression analyses were used to evaluate how changes in cognitive and somatic symptoms of depression over a 1-year period were related to cardiac and all-cause deaths over 2 years of follow-up.
Results: During the subsequent 1-year follow-up period, 50 (11.1%) patients died, of which 35 (7.8%) deaths were attributable to a cardiac cause. After adjustment for baseline somatic and cognitive scores and demographic and clinical characteristics (i.e., age, gender, EF, NYHA class, study group), the change in somatic symptoms of depression, as indicated by increased somatic PHQ-9 scores over a 1-year period, was associated with increased risk of cardiac death during the subsequent 1-year period (hazard ratio [HR] = 1.24, 95% confidence interval [CI]: 1.07 to 1.44, p = .004), but the change in cognitive symptoms was not (HR = 0.94, 95% CI: 0.81 to 1.08, p = .94). Similar results were found for all-cause mortality.
Conclusions: Worsening somatic depressive symptoms, not cognitive depressive symptoms, are associated with increased cardiac and all-cause mortality of HF patients, suggesting the need for routine and ongoing assessment of somatic depressive symptoms (i.e., appetite problems, sleeping difficulties, psychomotor agitation or retardation, and fatigue) in HF patients.
- © 2013 by American Heart Association, Inc.