Abstract 18336: Does the Interaction of B-Type Natriuretic Peptide and Depressive Symptom Status Predict Cardiac Mortality and Re-Hospitalization in Rural-Dwelling Heart Failure Patients?

Abstract

BACKGROUND: Identification of reduced and preserved left ventricular ejection fraction (LVEF) is a stratification used in heart failure (HF) management and prognosis. Elevated B-type natriuretic peptide (BNP) levels and depressive symptoms are independently associated with poor prognosis; however, their combined risk on cardiac death and re-hospitalization for HF is less clear. OBJECTIVE: To assess the combined effect of BNP and depressive symptoms on clinical outcomes in rural-dwelling HF patients with both reduced and preserved LVEF. METHODS: Baseline data were collected on 576 patients in the Rural Education to Improve Outcome in Heart Failure (REMOTE) trial. Measures included BNP levels and depressive symptoms (Patient Health Questionnaire [PHQ]-9). Patients were stratified into 4 groups by elevated and normal plasma BNP (>100 pg/ml and ≤100 pg/ml) and with and without depressive symptoms (PHQ-9 ≥ 10 and < 10). Outcomes were defined as composite 2-year endpoint of cardiac death or first HF re-hospitalization. RESULTS: There were 199 patients (35%) who had a cardiac event. Kaplan-Meier with log rank test showed the probability of event-free survival differed significantly depending on BNP and depressive symptom status (Figure). In multivariable Cox regression analysis, the risk of the composite endpoint for those with depressive symptoms alone was 0.8 (p = 0.85); with elevated BNP alone, 16.8 (p < 0.001); and combined, 13.1 (p = 0.003) compared to non-depressed patients with normal BNP, independent of other covariates. Composite risk was similar between elevated BNP groups with or without depressive symptoms (p = 0.56). However, LVEF significantly modified the effect (p interaction = 0.03); higher LVEF reduced composite risk in patients with elevated BNP alone (hazard ratio 0.96, p = 0.01). CONCLUSION: Combined effect of BNP and depressive symptoms on cardiac event risk may provide useful clinical data in the risk stratification and management of HF outcomes.