Association of Depression and Survival in Patients with Chronic Heart Failure over 12 Years

Objective To examine the relationship between depression and survival in patients with chronic heart failure (HF) over a 12-year follow-up period. Background The survival associated with depression has been demonstrated in HF patients for up to 7 years. Longer-term impact of depression on survival of these patients remains unknown. Methods Prospectively conducted observational study examining adults with HF who were admitted to a cardiology service at Duke University Medical Center between March 1997 and June 2003 and completed the Beck Depression Inventory (BDI) scale. The National Death Index was queried for vital status. Cox proportional hazards modeling was used to determine the association of survival and depression. Results During a mean follow-up of 1792.33 ± 1372.82 days (median 1600; range 0–4683), 733 of 985 participants with HF died of all causes, representing 80% of those with depression (BDI > 10) and 73% of those without (P = 0.01). Depression was significantly and persistently associated with decreased survival over follow-up (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.15–1.57), and was independent of conventional risk factors (HR 1.40, 95% CI 1.16–1.68). Furthermore, survival was inversely associated with depression severity (BDIcontinuous HR 1.02, 95% CI 1.006–1.025, P = 0.001). Conclusions The impact of co-morbid depression during the index hospitalization on significantly increased mortality of HF patients is strong and persists over 12 years. These findings suggest that more investigation is needed to understand the trajectory of depression and the mechanisms underlying the impact of depression as well as to identify effective management strategies for depression of patients with HF.