Am Fam Physician. 2007 Jun 1;75(11):1711.
Background: Recently, the association between depression and cardiovascular disease has become a major focus of depression research. Meta-analyses have demonstrated strong connections between depression and coronary artery disease (CAD), depression and premature mortality among patients with CAD, and depression and all-cause mortality in persons with or without CAD. Some studies have found that patients with heart failure have a high rate of clinical depression, and others have shown an increase in negative outcomes in patients with heart failure who also have symptoms of depression. Rutledge and colleagues used a meta-analysis to determine the prevalence of clinically significant depression in patients with heart failure; the association between depression and clinical outcomes from heart failure; and the impacts pharmacologic and nonpharmacologic treatments of depression have on patients with heart failure.
The Review: Two authors independently identified articles using Medline and PsycInfo. Reporting the rate of depression based on an interview or standardized questionnaire, describing the prospective relationship between depression and cardiac morbidity and mortality, and documenting changes in depression before and after treatment were all criteria for inclusion in the review.
Results: Twenty-seven studies were included in the analysis. The prevalence of clinically significant depression in patients with heart failure was 21.5 percent, but it was higher in patients who answered a standardized questionnaire compared with those who were interviewed. Eleven percent of patients with New York Heart Association functional class I had depression, and 42 percent with functional class IV had depression. An increased risk of death and clinical events was found in patients with heart failure who also had depression. These patients trended toward higher health care use, higher rates of hospitalization, and increased emergency department visits. Although six studies evaluatied treatment for depression in patients with heart failure, they all had one or more design flaws, such as small number of participants.
Conclusion: Depression occurs in approximately one out of five patients with heart failure, and it is more prevalent in those with more advanced heart failure. Moreover, there is a strong correlation between depression and poorer outcomes among patients with heart failure.
KARL E. MILLER, MD
Rutledge T, et al. Depression in heart failure: a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. October 17, 2006;48:1527–37
editor's note: There has been significant advancement in the understanding of the connection between physical and mental health. In this review, the prevalence of depression in patients with heart failure was found to be high. However, there were not enough adequate studies to show if treating depression improves outcomes. In another review, researchers noted the need for further research because no randomized controlled trials evaluate psychological interventions for depression in patients with heart failure.1 Physicians should be aware of the potential negative impact depression can have on patients with heart failure; therefore, treatment needs to be on a case-by-case basis until further research can be done.—k.e.m.
1Lane DA, Chong AY, Lip GY. Psychological interventions for depression in heart failure. Cochrane Database Syst Rev. 2005;(1):CD003329.
Copyright © 2007 by the American Academy of Family Physicians.
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