Depression As a Risk Factor for Developing Heart Failure: A Meta-Analysis of Prospective Cohort Studies

Background: The associations of depression with incident heart failure (HF) risk based on epidemiological studies have been inconsistent.

Objective: We aimed to quantitatively estimate the relative effect of depression on the development of HF.

Methods: We performed a systematic review and meta-analysis of cohort studies published between January 1, 1950, and August 31, 2019, from PubMed, Embase, and the Science Citation Index databases. We selected prospective cohort studies reporting the relationship between depression and incident HF. Maximally adjusted hazard ratios and their 95% confidence intervals were combined using a random-effects model. The heterogeneity across studies was calculated by the I2 statistic. This meta-analysis was registered in PROSPERO (number CRD42020149274).

Results: Six population-based, prospective cohort studies with 4727 HF events among 131 282 participants were eligible for meta-analysis. Compared with participants reporting no depression, those with depression had a 23% increased risk of developing HF (pooled hazard ratio, 1.23; 95% confidence interval, 1.08-1.41). There was no significant heterogeneity across studies (χ2 = 7.75, df = 5, P = .17, I2 = 35.5%).

Conclusion: Published literature supports a significant association of depression with an increased incidence of HF in the general population.