Disease-Specific Depression and Outcomes in Chronic Heart Failure: A Propensity Score Analysis

Depression is common in heart failure and is associated with increased mortality. Yet, it is often underdiagnosed and inadequately treated. Lack of disease-specific and easy-to-administer screening tools is one of the reasons for underdiagnosis of depression in heart failure. We examined the effect of depression, as diagnosed by a single question about depression caused by heart failure symptoms and affecting quality of life, in a propensity score-matched cohort of heart failure patients. Of the 581 patients enrolled in the quality-of-life sub-study of the Digitalis Investigation Group trial, 298 (51%) reported that their heart failure prevented them from living as they wanted during the last month by making them feel depressed. Seventy patients (23%) who reported that they felt “much” or “very much” depressed were considered depressed for the purpose of this study. We matched 47 (67%) of these depressed patients with 47 patients from among the 283 patients without depression. Kaplan–Meier and matched Cox regression analyses were used to estimate associations of depression with mortality and hospitalizations during a median follow up of 33 months. Compared with 8 (17%) deaths in patients in the non-depressed group, 19 (40%) of those in the depressed group died from all causes [unadjusted hazard ratio (HR), 1.55; 95% confidence interval (CI), 1.004–2.39; p = 0.048]. Adjustment for propensity scores (adjusted HR, 1.77; 95% CI, 1.04–3.00; p = 0.034) or other covariates (adjusted HR, 1.85; 95% CI, 1.12–3.04; p = 0.016) did not alter the association between depression and mortality. The association, however, became marginally significant in the matched cohort (HR, 2.50; 95% CI, 0.97–6.44; p = 0.058). There was no significant association between depression and hospitalization. Baseline depression, identified by a single disease-specific question, was associated with increased mortality among ambulatory chronic heart failure patients.