The Impact of Depression on Outcomes in Patients With Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial
•Depression is associated with adverse outcomes in patients with heart failure with reduced ejection fraction.•This association exists regardless of guideline-directed medical therapy intensity and amino-terminal pro-B-type natriuretic peptide levels.•No differences existed in guideline-directed med...
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| Veröffentlicht in: | Journal of cardiac failure 2021-12, Vol.27 (12), p.1359-1366 |
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| creator | CHOUAIRI, FOUAD FUERY, MICHAEL A. MULLAN, CLANCY W. CARABALLO, CESAR SEN, SOUNOK MAULION, CHRISTOPHER WILKINSON, SAMUEL T. SURTI, TORAL MCCULLOUGH, MEGAN MILLER, P. ELLIOTT PACOR, JUSTIN LEIFER, ERIC S. FELKER, G. MICHAEL VELAZQUEZ, ERIC J. FIUZAT, MONA O'CONNOR, CHRISTOPHER M. JANUZZI, JAMES L DESAI, NIHAR R. AHMAD, TARIQ |
| description | •Depression is associated with adverse outcomes in patients with heart failure with reduced ejection fraction.•This association exists regardless of guideline-directed medical therapy intensity and amino-terminal pro-B-type natriuretic peptide levels.•No differences existed in guideline-directed medical therapy of patients with heart failure with reduced ejection fraction based on depression status.•No differences existed in amino-terminal pro-B-type natriuretic peptide levels based on depression status.
It remains unclear why depression is associated with adverse outcomes in patients with heart failure (HF). We examine the relationship between depression and clinical outcomes among patients with HF with reduced ejection fraction managed with guideline-directed medical therapy (GDMT).
Using the GUIDE-IT trial, 894 patients with HF with reduced ejection fraction were stratified according to a history of depression, and Cox proportional hazards regression modeling was used to examine the association with outcomes. There were 140 patients (16%) in the overall cohort who had depression. They tended to be female (29% vs 46%, P < .001) and White (67% vs 53%, P = .002). There were no differences in GDMT rates at baseline or at 90 days; nor were there differences in target doses of these therapies achieved at 90 days (NS, all). amino-terminal pro-B-type natriuretic peptide levels at all time points were similar between the cohorts (P > .05, all). After adjustment, depression was associated with all-cause hospitalizations (hazard ratio, 1.42, 95% confidence interval 1.11–1.81, P < .01), cardiovascular death (hazard ratio, 1.69, 95% confidence interval 1.07–2.68, P = .025), and all-cause mortality (hazard ratio, 1.54, 95% confidence interval 1.03–2.32, P = .039).
Depression impacts clinical outcomes in HF regardless of GDMT intensity and amino-terminal pro-B-type natriuretic peptide levels. This finding underscores the need for a focus on mental health in parallel to achievement of optimal GDMT in these patients.
NCT01685840, https://clinicaltrials.gov/ct2/show/NCT01685840 |
| doi_str_mv | 10.1016/j.cardfail.2021.06.008 |
| format | Article |
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It remains unclear why depression is associated with adverse outcomes in patients with heart failure (HF). We examine the relationship between depression and clinical outcomes among patients with HF with reduced ejection fraction managed with guideline-directed medical therapy (GDMT).
Using the GUIDE-IT trial, 894 patients with HF with reduced ejection fraction were stratified according to a history of depression, and Cox proportional hazards regression modeling was used to examine the association with outcomes. There were 140 patients (16%) in the overall cohort who had depression. They tended to be female (29% vs 46%, P < .001) and White (67% vs 53%, P = .002). There were no differences in GDMT rates at baseline or at 90 days; nor were there differences in target doses of these therapies achieved at 90 days (NS, all). amino-terminal pro-B-type natriuretic peptide levels at all time points were similar between the cohorts (P > .05, all). After adjustment, depression was associated with all-cause hospitalizations (hazard ratio, 1.42, 95% confidence interval 1.11–1.81, P < .01), cardiovascular death (hazard ratio, 1.69, 95% confidence interval 1.07–2.68, P = .025), and all-cause mortality (hazard ratio, 1.54, 95% confidence interval 1.03–2.32, P = .039).
Depression impacts clinical outcomes in HF regardless of GDMT intensity and amino-terminal pro-B-type natriuretic peptide levels. This finding underscores the need for a focus on mental health in parallel to achievement of optimal GDMT in these patients.
NCT01685840, https://clinicaltrials.gov/ct2/show/NCT01685840</description><identifier>ISSN: 1071-9164</identifier><identifier>EISSN: 1532-8414</identifier><identifier>DOI: 10.1016/j.cardfail.2021.06.008</identifier><identifier>PMID: 34166799</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Depression ; Depression - epidemiology ; Female ; GUIDE-IT ; heart Failure ; Heart Failure - drug therapy ; Heart Failure - epidemiology ; Hospitalization ; Humans ; outcomes ; Proportional Hazards Models ; Stroke Volume</subject><ispartof>Journal of cardiac failure, 2021-12, Vol.27 (12), p.1359-1366</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c298t-f8dd020d976d77b1a3409104a9e9a8cb0f0eb51cc629ad4d5e6b87a8c6ba07a33</citedby><cites>FETCH-LOGICAL-c298t-f8dd020d976d77b1a3409104a9e9a8cb0f0eb51cc629ad4d5e6b87a8c6ba07a33</cites><orcidid>0000-0002-2510-4266 ; 0000-0001-8715-6718 ; 0000-0002-4557-9437 ; 0000-0002-8497-2629 ; 0000-0002-4412-2654 ; 0000-0002-2774-251X ; 0000-0002-5931-1239 ; 0000-0002-1806-3566 ; 0000-0001-9166-4838</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.cardfail.2021.06.008$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34166799$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>CHOUAIRI, FOUAD</creatorcontrib><creatorcontrib>FUERY, MICHAEL A.</creatorcontrib><creatorcontrib>MULLAN, CLANCY W.</creatorcontrib><creatorcontrib>CARABALLO, CESAR</creatorcontrib><creatorcontrib>SEN, SOUNOK</creatorcontrib><creatorcontrib>MAULION, CHRISTOPHER</creatorcontrib><creatorcontrib>WILKINSON, SAMUEL T.</creatorcontrib><creatorcontrib>SURTI, TORAL</creatorcontrib><creatorcontrib>MCCULLOUGH, MEGAN</creatorcontrib><creatorcontrib>MILLER, P. ELLIOTT</creatorcontrib><creatorcontrib>PACOR, JUSTIN</creatorcontrib><creatorcontrib>LEIFER, ERIC S.</creatorcontrib><creatorcontrib>FELKER, G. MICHAEL</creatorcontrib><creatorcontrib>VELAZQUEZ, ERIC J.</creatorcontrib><creatorcontrib>FIUZAT, MONA</creatorcontrib><creatorcontrib>O'CONNOR, CHRISTOPHER M.</creatorcontrib><creatorcontrib>JANUZZI, JAMES L</creatorcontrib><creatorcontrib>DESAI, NIHAR R.</creatorcontrib><creatorcontrib>AHMAD, TARIQ</creatorcontrib><title>The Impact of Depression on Outcomes in Patients With Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial</title><title>Journal of cardiac failure</title><addtitle>J Card Fail</addtitle><description>•Depression is associated with adverse outcomes in patients with heart failure with reduced ejection fraction.•This association exists regardless of guideline-directed medical therapy intensity and amino-terminal pro-B-type natriuretic peptide levels.•No differences existed in guideline-directed medical therapy of patients with heart failure with reduced ejection fraction based on depression status.•No differences existed in amino-terminal pro-B-type natriuretic peptide levels based on depression status.
It remains unclear why depression is associated with adverse outcomes in patients with heart failure (HF). We examine the relationship between depression and clinical outcomes among patients with HF with reduced ejection fraction managed with guideline-directed medical therapy (GDMT).
Using the GUIDE-IT trial, 894 patients with HF with reduced ejection fraction were stratified according to a history of depression, and Cox proportional hazards regression modeling was used to examine the association with outcomes. There were 140 patients (16%) in the overall cohort who had depression. They tended to be female (29% vs 46%, P < .001) and White (67% vs 53%, P = .002). There were no differences in GDMT rates at baseline or at 90 days; nor were there differences in target doses of these therapies achieved at 90 days (NS, all). amino-terminal pro-B-type natriuretic peptide levels at all time points were similar between the cohorts (P > .05, all). After adjustment, depression was associated with all-cause hospitalizations (hazard ratio, 1.42, 95% confidence interval 1.11–1.81, P < .01), cardiovascular death (hazard ratio, 1.69, 95% confidence interval 1.07–2.68, P = .025), and all-cause mortality (hazard ratio, 1.54, 95% confidence interval 1.03–2.32, P = .039).
Depression impacts clinical outcomes in HF regardless of GDMT intensity and amino-terminal pro-B-type natriuretic peptide levels. This finding underscores the need for a focus on mental health in parallel to achievement of optimal GDMT in these patients.
NCT01685840, https://clinicaltrials.gov/ct2/show/NCT01685840</description><subject>Depression</subject><subject>Depression - epidemiology</subject><subject>Female</subject><subject>GUIDE-IT</subject><subject>heart Failure</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - epidemiology</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>outcomes</subject><subject>Proportional Hazards Models</subject><subject>Stroke Volume</subject><issn>1071-9164</issn><issn>1532-8414</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1r3DAQhkVoaT7avxB07MXuyJZl-5aS7CYLgZSyoUcxlsZEiz-2khzIKX-9WjbJtTAwg-Z950UPY5cCcgFC_djlBr3t0Q15AYXIQeUAzQk7E1VZZI0U8lOaoRZZK5Q8Zech7CApJNRf2GkphVJ1256x1-0T8c24RxP53PMb2nsKwc0TT_WwRDOPFLib-C-MjqYY-B8Xn_gdoY98neIXTxwny3-TXQxZvtqRiQf_2uNx2HrCmDbpSExht4-bm1W22aZ3h8NX9rnHIdC3t37BHter7fVddv9wu7n-eZ-Zom1i1jfWQgG2rZWt605gKaEVILGlFhvTQQ_UVcIYVbRopa1IdU2dNqpDqLEsL9j34929n_8uFKIeXTA0DDjRvARdVLJSIKUoklQdpcbPIXjq9d67Ef2LFqAP8PVOv8PXB_galE5ok_HyLWPpRrIftnfaSXB1FFD66bMjr4NJUBM25xM1bWf3v4x_1WuZAw</recordid><startdate>202112</startdate><enddate>202112</enddate><creator>CHOUAIRI, FOUAD</creator><creator>FUERY, MICHAEL A.</creator><creator>MULLAN, CLANCY W.</creator><creator>CARABALLO, CESAR</creator><creator>SEN, SOUNOK</creator><creator>MAULION, CHRISTOPHER</creator><creator>WILKINSON, SAMUEL T.</creator><creator>SURTI, TORAL</creator><creator>MCCULLOUGH, MEGAN</creator><creator>MILLER, P. ELLIOTT</creator><creator>PACOR, JUSTIN</creator><creator>LEIFER, ERIC S.</creator><creator>FELKER, G. MICHAEL</creator><creator>VELAZQUEZ, ERIC J.</creator><creator>FIUZAT, MONA</creator><creator>O'CONNOR, CHRISTOPHER M.</creator><creator>JANUZZI, JAMES L</creator><creator>DESAI, NIHAR R.</creator><creator>AHMAD, TARIQ</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2510-4266</orcidid><orcidid>https://orcid.org/0000-0001-8715-6718</orcidid><orcidid>https://orcid.org/0000-0002-4557-9437</orcidid><orcidid>https://orcid.org/0000-0002-8497-2629</orcidid><orcidid>https://orcid.org/0000-0002-4412-2654</orcidid><orcidid>https://orcid.org/0000-0002-2774-251X</orcidid><orcidid>https://orcid.org/0000-0002-5931-1239</orcidid><orcidid>https://orcid.org/0000-0002-1806-3566</orcidid><orcidid>https://orcid.org/0000-0001-9166-4838</orcidid></search><sort><creationdate>202112</creationdate><title>The Impact of Depression on Outcomes in Patients With Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial</title><author>CHOUAIRI, FOUAD ; FUERY, MICHAEL A. ; MULLAN, CLANCY W. ; CARABALLO, CESAR ; SEN, SOUNOK ; MAULION, CHRISTOPHER ; WILKINSON, SAMUEL T. ; SURTI, TORAL ; MCCULLOUGH, MEGAN ; MILLER, P. ELLIOTT ; PACOR, JUSTIN ; LEIFER, ERIC S. ; FELKER, G. MICHAEL ; VELAZQUEZ, ERIC J. ; FIUZAT, MONA ; O'CONNOR, CHRISTOPHER M. ; JANUZZI, JAMES L ; DESAI, NIHAR R. ; AHMAD, TARIQ</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c298t-f8dd020d976d77b1a3409104a9e9a8cb0f0eb51cc629ad4d5e6b87a8c6ba07a33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Depression</topic><topic>Depression - epidemiology</topic><topic>Female</topic><topic>GUIDE-IT</topic><topic>heart Failure</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - epidemiology</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>outcomes</topic><topic>Proportional Hazards Models</topic><topic>Stroke Volume</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>CHOUAIRI, FOUAD</creatorcontrib><creatorcontrib>FUERY, MICHAEL A.</creatorcontrib><creatorcontrib>MULLAN, CLANCY W.</creatorcontrib><creatorcontrib>CARABALLO, CESAR</creatorcontrib><creatorcontrib>SEN, SOUNOK</creatorcontrib><creatorcontrib>MAULION, CHRISTOPHER</creatorcontrib><creatorcontrib>WILKINSON, SAMUEL T.</creatorcontrib><creatorcontrib>SURTI, TORAL</creatorcontrib><creatorcontrib>MCCULLOUGH, MEGAN</creatorcontrib><creatorcontrib>MILLER, P. ELLIOTT</creatorcontrib><creatorcontrib>PACOR, JUSTIN</creatorcontrib><creatorcontrib>LEIFER, ERIC S.</creatorcontrib><creatorcontrib>FELKER, G. MICHAEL</creatorcontrib><creatorcontrib>VELAZQUEZ, ERIC J.</creatorcontrib><creatorcontrib>FIUZAT, MONA</creatorcontrib><creatorcontrib>O'CONNOR, CHRISTOPHER M.</creatorcontrib><creatorcontrib>JANUZZI, JAMES L</creatorcontrib><creatorcontrib>DESAI, NIHAR R.</creatorcontrib><creatorcontrib>AHMAD, TARIQ</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiac failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>CHOUAIRI, FOUAD</au><au>FUERY, MICHAEL A.</au><au>MULLAN, CLANCY W.</au><au>CARABALLO, CESAR</au><au>SEN, SOUNOK</au><au>MAULION, CHRISTOPHER</au><au>WILKINSON, SAMUEL T.</au><au>SURTI, TORAL</au><au>MCCULLOUGH, MEGAN</au><au>MILLER, P. ELLIOTT</au><au>PACOR, JUSTIN</au><au>LEIFER, ERIC S.</au><au>FELKER, G. MICHAEL</au><au>VELAZQUEZ, ERIC J.</au><au>FIUZAT, MONA</au><au>O'CONNOR, CHRISTOPHER M.</au><au>JANUZZI, JAMES L</au><au>DESAI, NIHAR R.</au><au>AHMAD, TARIQ</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Impact of Depression on Outcomes in Patients With Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial</atitle><jtitle>Journal of cardiac failure</jtitle><addtitle>J Card Fail</addtitle><date>2021-12</date><risdate>2021</risdate><volume>27</volume><issue>12</issue><spage>1359</spage><epage>1366</epage><pages>1359-1366</pages><issn>1071-9164</issn><eissn>1532-8414</eissn><abstract>•Depression is associated with adverse outcomes in patients with heart failure with reduced ejection fraction.•This association exists regardless of guideline-directed medical therapy intensity and amino-terminal pro-B-type natriuretic peptide levels.•No differences existed in guideline-directed medical therapy of patients with heart failure with reduced ejection fraction based on depression status.•No differences existed in amino-terminal pro-B-type natriuretic peptide levels based on depression status.
It remains unclear why depression is associated with adverse outcomes in patients with heart failure (HF). We examine the relationship between depression and clinical outcomes among patients with HF with reduced ejection fraction managed with guideline-directed medical therapy (GDMT).
Using the GUIDE-IT trial, 894 patients with HF with reduced ejection fraction were stratified according to a history of depression, and Cox proportional hazards regression modeling was used to examine the association with outcomes. There were 140 patients (16%) in the overall cohort who had depression. They tended to be female (29% vs 46%, P < .001) and White (67% vs 53%, P = .002). There were no differences in GDMT rates at baseline or at 90 days; nor were there differences in target doses of these therapies achieved at 90 days (NS, all). amino-terminal pro-B-type natriuretic peptide levels at all time points were similar between the cohorts (P > .05, all). After adjustment, depression was associated with all-cause hospitalizations (hazard ratio, 1.42, 95% confidence interval 1.11–1.81, P < .01), cardiovascular death (hazard ratio, 1.69, 95% confidence interval 1.07–2.68, P = .025), and all-cause mortality (hazard ratio, 1.54, 95% confidence interval 1.03–2.32, P = .039).
Depression impacts clinical outcomes in HF regardless of GDMT intensity and amino-terminal pro-B-type natriuretic peptide levels. This finding underscores the need for a focus on mental health in parallel to achievement of optimal GDMT in these patients.
NCT01685840, https://clinicaltrials.gov/ct2/show/NCT01685840</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34166799</pmid><doi>10.1016/j.cardfail.2021.06.008</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2510-4266</orcidid><orcidid>https://orcid.org/0000-0001-8715-6718</orcidid><orcidid>https://orcid.org/0000-0002-4557-9437</orcidid><orcidid>https://orcid.org/0000-0002-8497-2629</orcidid><orcidid>https://orcid.org/0000-0002-4412-2654</orcidid><orcidid>https://orcid.org/0000-0002-2774-251X</orcidid><orcidid>https://orcid.org/0000-0002-5931-1239</orcidid><orcidid>https://orcid.org/0000-0002-1806-3566</orcidid><orcidid>https://orcid.org/0000-0001-9166-4838</orcidid></addata></record> |
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| ispartof | Journal of cardiac failure, 2021-12, Vol.27 (12), p.1359-1366 |
| issn | 1071-9164 1532-8414 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Depression Depression - epidemiology Female GUIDE-IT heart Failure Heart Failure - drug therapy Heart Failure - epidemiology Hospitalization Humans outcomes Proportional Hazards Models Stroke Volume |
| title | The Impact of Depression on Outcomes in Patients With Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial |
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