Depression and its relation to prognosis in patients with heart failure

Introduction. Depression has a strong link in patients with heart failure, influencing its morbidity, mortality and treatment.
Objectives. To describe the clinical, laboratory, electrocardiographic, echocardiographic and cardiovascular risk factors of patients with chronic heart failure (CHF) with and without a probable diagnosis of depression. To evaluate the association between the presence of depression and poor prognosis in patients with chronic systolic and/or diastolic heart failure.
Material and methods. A prospective cohort study was conducted in 80 patients with a diagnosis of CHF. The psychological evaluation was performed with the World Health Organization (WHO) test to determine probability of depression. Laboratory, clinical and electrocardiographic parameters were evaluated. Echocardiogram (M-mode and two-dimensional) was performed at the time of admission and both systolic and/or diastolic heart failure were considered.
Results. We included 80 patients, 38 patients with probable diagnosis of depression and 42 without probable diagnosis of depression with an average age of 59.53 ± 12.34 vs 66.88 ± 15.67 years, respectively; 49% female. Depression was significantly associated with age (59.53 ± 12.34 years vs 66.88 ± 15.67 years, p=0.01), with diastolic blood pressure (78.82 ± 11.36 mm Hg vs 80.00 ± 11.09 mm Hg, p=0.01), with systolic blood pressure (124.08 ± 18.74 mm Hg vs 127.50 ± 14.63 mm Hg, p=0.01), with heart rate (71.74 ± 10.77 bpm vs 72.85 ± 13.49 bpm, p=0.01), with creatininemia (11.01 ± 3.42 mg/dL vs 12.63 ± 4,47 mg/dL; p=0.01), with natremia (138.82± 3.76 mEq/L vs 136.58 ± 3.53 mEq/L; p = 0.01), with hemoglobin levels (13.76 ± 1.56 mg/dL vs 13.01 ± 1.79 mg/dL, p=0.01), with the ejection fraction of the left ventricle (56.87 ± 12.69% vs 58.87 ± 12.61%, p=0.01) and previous acute myocardial infarction (80.62% vs 54.65%, p=0.01). No statistically significant association was found in type of HF, functional class (according to the New York Heart Association), in hospitalizations and mortality of the population.
Conclusion. Although the prevalence of depression in patients with both systolic and diastolic heart failure is high, further investigations and randomized studies will be necessary to complete the knowledge and to detect this co-morbidity early, whose potential effect is negative in patients with heart failure.

Keywords: Depression; Heart failure; Prevalence; Diagnosis