Prevalence of depression in a cohort of patients at a chronic heart failure unit

Abstract

Relevance of the topic: depression is a risk factor associated to a greater incidence of coronary pathologies; it is also considered a negative prognostic factor in patients with heart disease. Depression is associated to an increase in the risk of suffering from heart failure in patients who are prone to suffer it, and has negative consequences in those who already suffer from the condition.
Patients with heart failure (HF) and depression evidence greater chances of being hospitalizing and dying. Depression is associated to the severity of the disease in these patients.
The Multidisciplinary Unit of Heart Failure (UMIC) is a program devised to follow up ambulatory patients throughout all stages of the condition.
Objectives: to determine the prevalence of depression in the cohort of patients under follow-up by the Multidisciplinary Unit of Heart Failure (UMIC) and to analyse the potential association of depression with clinical and paraclinical variables: NYHA functional classification (CFNYHA) and left ventricular ejection fraction (LVEF).
Method: transversal descriptive, observational study of 151 patients with HF. Inclusion criteria: belonging to the cohort of patients under follow-up by the Multidisciplinary Unit of Heart Failure (UMIC) (HF for systolic dysfunction with LVEF lower than 40%), being clinically stable and agreeing, by means of a written consent, to being interviewed and undergoing the test. Exclusion criteria: clinical instability due to cardiovascular decompensation elements and cognitive, neurologic or hearing impairments that do not allow for the interview to be conducted.
The test validated by Patients Health Questionnaire 9 (PHQ9) was applied, and the cut off was set in a value ≥ 15 to define depression, with a 0.96 of specificity.
Results: 151 patients were included in the cohort of patients under follow-up by UMIC. The PHQ9 revealed that 29.8% (n=45) showed moderately severe or severe major depression (PHQ9 ≥ 15). Average age of patients with depression was 59.1 ± 1.8 years (20-80 range) and patients with no depression 61.5 ± 1.2 years (25-82 range). There were no statistically significant differences between the groups with and without depression in terms of age.
As to the association of depression and gender and functional classification with depression, no association among variables was found (p=0.287 y p=0.515).
No statistically significant differences were found in the NYHA functional classification according to the presence or absence of depression (p=0.655), neither in the association of LVEF with patients with or without depression (p=0.457).
Conclusions: depression is considered today as a comorbility factor in HF, adding up to 29.8% in the cohort of patients under follow-up by the UMIC. The presence of depression identifies a group of patients with a worse prognosis. We emphasize on the usefulness of the implementation of a simple screening test to identify this condition. The study did not find an association between the presence of depression and age or gender, neither with severity of HF prognosis factors such as the NYHA functional classification of the LVEF. The confirmation of this prevalence values needs to be pointed out given the larger risk the presence of depression implies in patients with HF.