Almost half of the heart failure outpatients given standard questionnaires scored as being depressed, according to a new study in the May 5, 2004 issue of the Journal of the American College of Cardiology.
"Depression is probably very important both in evaluating patients with heart failure and in affecting how they feel. We can't ignore depression in these patients. And unless we deal with their depression, we can't improve the symptoms of these patients as much as we would like," said Stephen S. Gottlieb, MD, FACC from the University of Maryland School of Medicine in Baltimore.
The study also involved researchers at the University of Maryland School of Nursing and the Baltimore Veterans Administration Medical Center, as well as Brooklyn College in Brooklyn, New York.
Most previous studies of heart failure and depression have involved hospitalized patients. For this study, the researchers recruited 155 outpatients with stable heart failure. Each participant completed three standard questionnaires to assess general quality of life, the specific influence of heart failure on quality of life, and depression.
A total of 48 percent of the patients scored as depressed. Depressed patients tended to be younger than non-depressed patients. Women were more likely (64%) to be depressed than men (44%). Among men, blacks (34%) tended to have less depression than whites (54%). Depressed patients scored significantly worse than non-depressed patients on all components of both the questionnaires measuring quality of life. However, they did not differ in ejection fraction (a measure of heart function) or treatment, except that depressed patients were significantly less likely to be receiving beta-blockers. Although beta-blockers are commonly thought to raise the risk of depression, this study and a recent meta-analysis of other studies did not see evidence of such a link.
The depressed patients reported lower quality of life and less ability to exercise. The researchers noted that in a previous study, depressed patients actually performed better on an exercise test than patients who weren't depressed. Dr. Gottlieb noted that other studies have linked depression to personal expectations, which may help explain why younger patients were more likely to score as depressed.
This study provided just a snapshot of depression in this group of heart failure patients and did not look at links between depression and eventual health outcomes. Dr. Gottlieb said the specific percentages of depressed patients are less important than the overall picture.
"The prevalence of depression in this heart failure population was very large. Many people with congestive heart failure score as being depressed on commonly accepted questionnaires," Dr. Gottlieb said.
Dr. Gottlieb said physicians should look for signs of depression in their heart failure patients. The researchers also called for more studies that specifically evaluate the effectiveness of depression treatments in patients with heart failure.