Is depression a warning sign for heart failure?
Symptoms of depression are associated with an elevated risk of heart failure with preserved ejection fraction (HFpEF), according to new data published in the Journal of the American Heart Association. The same is not true, however, for heart failure with reduced ejection fraction (HFrEF).
The study's authors examined Atherosclerosis Risk in Communities (ARIC) data from a total of 15,792 patients who underwent four separate visits between 1987 and 1998. More than 6,000 of those patients came back for a fifth visit from 2011 to 2013, when they were subjected to comprehensive echocardiography and asked to complete the Center for Epidemiologic Studies Depression Scale (CES‐D) questionnaire. Fifty-nine percent of those patients were women, and the mean patient age was 75.3 years old.
There were a total of 5,086 heart failure (HF)-free patients included in the analysis. The median CES-D score was two, and severe depressive symptoms—defined as a CES-D score greater than nine—were seen in 6% of the group.
Severe depressive symptoms were also seen 7% of patients with prevalent HFrEF and 13% of patients with prevalent HFpEF. The prevalence of these severe symptoms, the authors noted, "did not statistically differ" between patients with HFrEF and HFpEF.
Of the 303 HF episodes that occurred over the 5.5-year follow-up, 42% were classified as HFrEF, 45% were classified as HFpEF, and LV ejection fraction was not available in 14%.
Worse depressive symptoms were independently linked to HFpEF—but not HFrEF—in late life. Such symptoms were linked to HFrEF at first, but that association "attenuated appreciably" after adjusting for certain factors.
The study's authors noted that, to the best of their knowledge, they were the first researchers to specifically examine the potential relationship between depressive symptoms and HFpEF/HFrEF.
“Our results indicate a higher prevalence of depression in HFpEF, but not HFrEF, compared with HF‐free participants," wrote lead author Katja Vu, MD, of Brigham and Women’s Hospital and Harvard Medical School, and colleagues. "However, the number of participants with severe depressive symptoms in the HFpEF and HFrEF groups was relatively small, which limited the power of our analysis. Therefore, these findings should be evaluated further in future studies with larger sample sizes."
Read the full study here.