Prognostic value of post-discharge depression in patients recently hospitalized with acute heart failure
BackgroundDepression is a prevalent comorbidity in patients with heart failure (HF). However, data regarding the prognostic significance of depression during the early post-discharge period in patients hospitalized with acute HF, regardless of left ventricular ejection fraction (LVEF), were scarce.M...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-08-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.858751/full |
| _version_ | 1818500187116535808 |
|---|---|
| author | Junlei Li Junlei Li Chao Jiang Rong Liu Yiwei Lai Li Li Xiaoyan Zhao Xiaofang Wang Ling Li Xin Du Xin Du Xin Du Changsheng Ma Jianzeng Dong Jianzeng Dong |
| author_facet | Junlei Li Junlei Li Chao Jiang Rong Liu Yiwei Lai Li Li Xiaoyan Zhao Xiaofang Wang Ling Li Xin Du Xin Du Xin Du Changsheng Ma Jianzeng Dong Jianzeng Dong |
| author_sort | Junlei Li |
| collection | DOAJ |
| description | BackgroundDepression is a prevalent comorbidity in patients with heart failure (HF). However, data regarding the prognostic significance of depression during the early post-discharge period in patients hospitalized with acute HF, regardless of left ventricular ejection fraction (LVEF), were scarce.Methods and resultsThe Heart Failure Registry of Patient Outcomes (HERO) study is a prospective, multicenter study of patients hospitalized with acute HF in China. At the first follow-up after discharge (median 4.0, interquartile range [IQR]: 2.4–6.1 weeks), depressive symptoms over the past 2 weeks were assessed using the Patient Health Questionnaire-9 (PHQ-9). Of 3,889 patients, 480 (12.3%) patients had depression (PHQ-9 score ≥ 10). A total of 3,456 patients (11.4% with depression) were included in the prospective analysis. After a median follow-up of 47.1 weeks (IQR: 43.9, 49.3) from the first follow-up, 508 (14.7%) patients died, and 1,479 (42.8%) patients experienced a composite event (death or HF rehospitalization). Cox proportional hazards models were used to assess the association of post-discharge depression with adverse events. After adjustment, post-discharge depression was associated with an increased risk of all-cause mortality (hazard ratio [HR] 2.38 [95% confidence interval (CI): 1.93–2.94]; p < 0.001) and the composite event (HR 1.78 [95% CI: 1.55–2.05]; p < 0.001). A per scale point increase in PHQ-9 score (ranging from 0 to 27 points) was associated with a 7.6% increase in all-cause mortality (HR 1.08 [95% CI: 1.06–1.09]; p < 0.001). In the subgroup analysis, the association between depression and the composite event was significantly stronger in relatively younger patients (< 75 vs. ≥ 75 years; p for interaction = 0.011), and the association between depression and all-cause mortality was significantly stronger in patients with preserved ejection fraction than in those with reduced ejection fraction (p for interaction = 0.036).ConclusionPost-discharge depression in patients recently hospitalized with acute HF is associated with an increased risk of adverse events, regardless of LVEF. Screening for depressive symptoms during the early post-discharge period may help to better identify high-risk patients and tailor patient management. Further studies are needed to determine how regular depression screening can help improve patient management and clinical outcomes. |
| first_indexed | 2024-12-10T20:39:26Z |
| format | Article |
| id | doaj.art-cae719d86ff34dc0af37ca3f8378f138 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-10T20:39:26Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-cae719d86ff34dc0af37ca3f8378f1382022-12-22T01:34:26ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-08-01910.3389/fcvm.2022.858751858751Prognostic value of post-discharge depression in patients recently hospitalized with acute heart failureJunlei Li0Junlei Li1Chao Jiang2Rong Liu3Yiwei Lai4Li Li5Xiaoyan Zhao6Xiaofang Wang7Ling Li8Xin Du9Xin Du10Xin Du11Changsheng Ma12Jianzeng Dong13Jianzeng Dong14Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaDepartment of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, ChinaDepartment of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, ChinaHeart Health Research Center (HHRC), Beijing, ChinaDepartment of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, ChinaDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaDepartment of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, ChinaHeart Health Research Center (HHRC), Beijing, ChinaThe George Institute for Global Health, The University of New South Wales, Sydney, NSW, AustraliaDepartment of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, ChinaDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaDepartment of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, ChinaBackgroundDepression is a prevalent comorbidity in patients with heart failure (HF). However, data regarding the prognostic significance of depression during the early post-discharge period in patients hospitalized with acute HF, regardless of left ventricular ejection fraction (LVEF), were scarce.Methods and resultsThe Heart Failure Registry of Patient Outcomes (HERO) study is a prospective, multicenter study of patients hospitalized with acute HF in China. At the first follow-up after discharge (median 4.0, interquartile range [IQR]: 2.4–6.1 weeks), depressive symptoms over the past 2 weeks were assessed using the Patient Health Questionnaire-9 (PHQ-9). Of 3,889 patients, 480 (12.3%) patients had depression (PHQ-9 score ≥ 10). A total of 3,456 patients (11.4% with depression) were included in the prospective analysis. After a median follow-up of 47.1 weeks (IQR: 43.9, 49.3) from the first follow-up, 508 (14.7%) patients died, and 1,479 (42.8%) patients experienced a composite event (death or HF rehospitalization). Cox proportional hazards models were used to assess the association of post-discharge depression with adverse events. After adjustment, post-discharge depression was associated with an increased risk of all-cause mortality (hazard ratio [HR] 2.38 [95% confidence interval (CI): 1.93–2.94]; p < 0.001) and the composite event (HR 1.78 [95% CI: 1.55–2.05]; p < 0.001). A per scale point increase in PHQ-9 score (ranging from 0 to 27 points) was associated with a 7.6% increase in all-cause mortality (HR 1.08 [95% CI: 1.06–1.09]; p < 0.001). In the subgroup analysis, the association between depression and the composite event was significantly stronger in relatively younger patients (< 75 vs. ≥ 75 years; p for interaction = 0.011), and the association between depression and all-cause mortality was significantly stronger in patients with preserved ejection fraction than in those with reduced ejection fraction (p for interaction = 0.036).ConclusionPost-discharge depression in patients recently hospitalized with acute HF is associated with an increased risk of adverse events, regardless of LVEF. Screening for depressive symptoms during the early post-discharge period may help to better identify high-risk patients and tailor patient management. Further studies are needed to determine how regular depression screening can help improve patient management and clinical outcomes.https://www.frontiersin.org/articles/10.3389/fcvm.2022.858751/fullacute heart failuredepressionheart failure hospitalizationearly post-discharge periodheart failure with preserved ejection fraction |
| spellingShingle | Junlei Li Junlei Li Chao Jiang Rong Liu Yiwei Lai Li Li Xiaoyan Zhao Xiaofang Wang Ling Li Xin Du Xin Du Xin Du Changsheng Ma Jianzeng Dong Jianzeng Dong Prognostic value of post-discharge depression in patients recently hospitalized with acute heart failure Frontiers in Cardiovascular Medicine acute heart failure depression heart failure hospitalization early post-discharge period heart failure with preserved ejection fraction |
| title | Prognostic value of post-discharge depression in patients recently hospitalized with acute heart failure |
| title_full | Prognostic value of post-discharge depression in patients recently hospitalized with acute heart failure |
| title_fullStr | Prognostic value of post-discharge depression in patients recently hospitalized with acute heart failure |
| title_full_unstemmed | Prognostic value of post-discharge depression in patients recently hospitalized with acute heart failure |
| title_short | Prognostic value of post-discharge depression in patients recently hospitalized with acute heart failure |
| title_sort | prognostic value of post discharge depression in patients recently hospitalized with acute heart failure |
| topic | acute heart failure depression heart failure hospitalization early post-discharge period heart failure with preserved ejection fraction |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.858751/full |
| work_keys_str_mv | AT junleili prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT junleili prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT chaojiang prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT rongliu prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT yiweilai prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT lili prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT xiaoyanzhao prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT xiaofangwang prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT lingli prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT xindu prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT xindu prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT xindu prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT changshengma prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT jianzengdong prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure AT jianzengdong prognosticvalueofpostdischargedepressioninpatientsrecentlyhospitalizedwithacuteheartfailure |