Relationship Between Depressive Symptoms and Long-term Mortality in Patients with Heart Failure

Background: Depression is prevalent in patients with heart failure (HF) and is associated with short-term poor prognosis. However, the long-term effect of depression and the use of self-administered depression evaluation on HF prognosis remained unknown. The study sought to assess the association of depressive symptoms and long-term mortality of patients with HF and to explore the prognostic predictability of the Beck Depression Inventory (BDI) scale for patients with HF.

Methods: Hospitalized patients with HF between March 1997 and June 2003 were recruited. All participants were given the self-administered BDI scale for depression assessment during the index admission. They were then followed for 6 months for the collection of vital status, and annually thereafter.

Results: Total study population comprises 1006 patients. The mean BDI score was 8.3 +/- 7.1. The average days of follow-up were 971 +/- 730 and the vital status was obtained from all participants. During this period, 42.6% of the participants died. Depression (defined by BDI score > or = 10) was significantly and independently associated with reduced survival (adjusted hazard ratio 1.36, 95% CI 1.09-1.70, P < .001). Patients whose BDI scores were 5 to 9, 10 to 18, and > or = 19 were 21%, 53%, and 83% more likely to die, respectively, than patients whose BDI score was < 5 (P < .001).

Conclusions: Self-rated depression by BDI is independently linked with higher long-term mortality in patients with HF. Significant dose effect of depressive symptoms on higher mortality is noted.