Time-course of depressive symptoms in patients with heart failure

• Background It is unclear how depressive symptoms in patients with heart failure developover time and whether this trajectory of depressive symptoms is associated with hospital admission and prognosis.Aim To describe the time-course of depressive symptoms and determine the relationship with hospital admission and mortality.Method Data was analysed using 611 patients with completed CES-D questionnaires at baseline and at 18 months. Data on hospital readmission was collected 18 months after discharge and data on mortality was collected 18 and 36 months post-discharge.Results The prevalence of depressive symptoms was 38% (n=229) at discharge and 26% (n=160) after 18 months. A total of 140 (61%) of the 229 patients with depressive symptoms at discharge had recovered from depressive symptoms after 18 months whereas 71 (18%) of the 382 non-depressed developed depressive symptoms and 89 (39%) of the 229 depressed remained depressed. Depressive symptoms at discharge were not associated with mortality after 18 months but patients with recently (i.e. during 18 months) developed depressive symptoms showed a significantly higher risk for cardiovascular readmissions (HR 1.7, p=0.016). After 36 months, patients with developed depressive symptoms after discharge were at a higher risk of all-cause mortality (HR 2.0, p=0.012) and there was a trend towards a higher risk of all-cause mortality in patients with ongoing depressive symptoms (HR 1.7, p=0.056).Conclusion A significant proportion of patients with HF, who were reported depressive symptoms at discharge recovered from depressive symptoms during the following 18 months. However, patients who remained having depressive symptoms or patients who developed depressive symptoms had a worse prognosis.

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