Duke researchers report that patients with congestive heart failure and major depression may face a greater risk of re-hospitalization or death than their non-depressed counterparts.
"This is the first work that has shown a relationship in patients with heart failure and depression," said researcher Dr. Christopher O'Connor, associate professor of medicine and director of Duke's Heart Failure Program. "Physicians are good at looking at traditional signs of cardiovascular failure, but now that we know depression is also a risk factor in heart disease, we will have to pay more attention to depression in general."
Researchers found that depressed patients with heart failure were four times as likely to be re-hospitalized and two-and-a-half times as likely to die as non-depressed patients. These differing rates were noticeable as early as three months after hospital discharge. Of the 375 patients the researchers screened over a 16-month period, about 35 percent showed symptoms of depression, and nearly 14 percent were diagnosed with major depression. The researchers also found that the effect of major depression was independent of traditional risk factors like severity and type of heart failure and age, O'Connor said.
Although studies linking the treatment of depression with heart failure have not yet been conducted, lead author Weiwen Jiang, a research associate in medicine, said these findings show promise for developing new strategies to help those with heart problems.
"It is clear that depression has a significant impact on [congestive heart failure patients], and at a much earlier time. If we can improve their depression, we may be able to significantly improve outcomes for patients with heart failure," she said.
The study results were released in the Archives of Internal Medicine last month.
Although the researchers have many hypotheses about the link between depression and heart failure, they are not certain of the precise explanation. "There really aren't any good answers why, but it's probably because depression is associated with high levels of platelet activity, which create clots in arteries," Jiang said.
O'Connor said depressed patients are less compliant with their medications because their hopelessness leads to unwillingness. Depression also adversely alters the electrical function of the heart and could lead to general heart problems.
Understanding the exact relationship between depression and heart failure will be the new focus for the researchers. "We need to find out what kind of depression treatments for this population will improve their prognosis. Then we need to find out by what mechanism the depression works so we may be able to develop more powerful treatments [to produce] more positive outcomes for these patients," Jiang said.
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