1Department of Cardiology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands2Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands3College of Nursing, University of Kentucky, Lexington, KY, USA4Health Psychology Section, Department of Health Science, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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AimsTo study the prognostic value of depressive symptoms on heart failure (HF) readmission and mortality, in a large and clinically relevant population of hospitalized HF patients adjusted for disease severity by B-type natriuretic peptide (BNP) level.Methods and resultsWe studied 958 patients enrolled after hospitalization for HF; 37% female; mean age 71 ± 11 years; New York Heart Association class II (51%) or III/IV (49%). Left ventricular ejection fraction: 33% ± 14%, and median BNP level: 454 pg/mL (75% CI, 195–876 pg/mL). In total, 377 patients (39%) had depressive symptoms [Centre for Epidemiological Studies Depression Scale (CES-D) score ≥16] and 200 (21%) had severe depressive symptoms (score ≥24). During 18 months of follow-up, 386 (40%) patients reached the primary endpoint of death or readmission for HF. In multivariate analyses, CES-D was significantly associated with the primary endpoint [hazard ratio (HR) 1.13, P=0.02], and also with both individual components of the primary endpoint [HF readmission (HR 1.165, P=0.02) and mortality (HR 1.169, P=0.02)]. Patients with severe depressive symptoms had a >40% higher risk for HF readmission or death.ConclusionIn patients with HF, depression is independently associated with poor outcomes. These findings highlight the need for continued exploration of whether improvements in depression lead to better cardiovascular outcomes.The study was registered at clinical trial (www.trialregister.nl): NCT 98675639.