Depression and Congestive Heart Failure

Thomas P. Guck, PhD, Gary N. Elsasser, PharmD, Michael G. Kavan, PhD, Eugene J. Barone, MD

CHF. 2003;9(3) 

In This Article

Abstract and Introduction

The prevalence rates of depression in congestive heart failure patients range from 24%-42%. Depression is a graded, independent risk factor for readmission to the hospital, functional decline, and mortality in patients with congestive heart failure. Physicians can assess depression by using the SIG E CAPS + mood mnemonic, or any of a number of easily administered and scored self-report inventories. Cognitive-behavior therapy is the preferred psychological treatment. Cognitive-behavior therapy emphasizes the reciprocal interactions among physiology, environmental events, thoughts, and behaviors, and how these may be altered to produce changes in mood and behavior. Pharmacologically, the selective serotonin reuptake inhibitors are recommended, whereas the tricyclic antidepressants are not recommended for depression in congestive heart failure patients. The combination of a selective serotonin reuptake inhibitor with cognitive-behavior therapy is often the most effective treatment.

Major depression has been reported in 15%-22% of patients suffering from acute cardiovascular disease, with as many as 65% reporting some symptoms of depression.[1] Further, depression has been well established as an independent risk factor contributing to poorer outcome and mortality in patients with coronary heart disease.[2,3,4]

The relationship between depression and congestive heart failure (CHF) has only recently been examined. Somewhere between 2 and 3 million Americans suffer from CHF.[5,6] Approximately 400,000 new cases of CHF are diagnosed each year.[7] The prevalence rates of depression in CHF samples range from 24%-42%.[8,9] Vaccarino et al.[10] found that 35%, 33.5%, and 9% of a sample of CHF patients 50 years of age or older reported mild, moderate, or severe depression, respectively. Jiang and colleagues[11] reported that 13.9% of 374 CHF patients 18 years or older met criteria for a major depressive disorder, while 35.3% of the sample reported Beck depression scores of 10 or higher.

Depression has been found to be significantly related to reduced functional status, higher readmission rates, and increased mortality in CHF patients. A recent study found a strong and graded relationship between the severity of depressive symptoms at baseline and functional decline and death at 6 months follow-up. The strong relationship remained even after statistical adjustment for demographic factors, medical history, baseline functional status, and clinical severity.[10] Another study found that major depression was associated with increased readmission and mortality at 3-month and 1-year follow-up, independently of age, New York Heart Association class, baseline ejection fraction, and ischemic etiology of CHF. CHF patients who had major depression were more than twice as likely as nondepressed patients to be readmitted or die.[11] Clearly, these recent findings provide strong evidence that depressive symptoms are an independent risk factor for patients with CHF, just as they are for patients with coronary heart disease.

Due to the high prevalence of depression in patients with CHF, it is important for physicians to accurately assess their patients for this disorder. Although figures specific to CHF are not available, it is estimated that fewer than 25% of cardiac patients with major depression are diagnosed as depressed, and only about one half of cardiac patients diagnosed as depressed received treatment for depression.[12] Depression may be undiagnosed and untreated in cardiac patients because: 1) physicians may be reluctant to ask; 2) patients may be hesitant to report depressive symptoms; 3) physicians and patients may mistakenly believe that depression is a normal reaction rather than a more serious but treatable disorder; and 4) many symptoms, such as fatigue, low energy, sleep disturbances, weight loss or gain, and concentration and memory problems, which are common in both CHF and depression, may be diagnosed as symptomatic only of CHF.[1,9]


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