Abstract
Introduction: Chronic systolic heart failure (CHF) is a major cause of death and hospitalization. There is growing interest in psychosomatic factors impacting on outcome in CHF. Both obesity and cachexia were shown to influence the outcome of CHF patients. We investigated the prevalence and prognostic impact of eating disorders (reduced appetite or overeating) on mortality risk in CHF. Hypothesis: Reduced appetite or overeating predict reduced survival in CHF. Methods: 864 patients hospitalized for cardiac decompensation with left ventricular ejection fraction <40% (mean age 67 years, 72% male,) were examined after best possible recompensation prior to discharge using the Patient Health Questionnaire (PHQ-9). The PHQ-9 is a 9-item self-administered questionnaire for identification and semi-quantitative assessment of suspected depression. Question #5 addresses poor appetite or overeating. The survival status was reassessed after a median follow-up of 18 months. Cox proportional hazards regression was used to determine the relationship between reported poor appetite or overeating and survival. Results: At baseline, poor appetite or overeating were reported “not at all” by 403 patients (figure, line 1), “on several days” by 272 patients (line 2), “more than half of all days” by 81 patients and (line 3), “nearly every day” by 101 patients (line 4). At follow-up, 156 patients (18%) had died. All-cause mortality risk was increased in all patient groups with eating disorders: hazard ratio(line 4) 2.7 (95%CI 1.7-4.2; p<0.001), HR(line 3) 2.6 (95%CI 1.6-41.2; p<0.001), HR(line 2) 1.5 (95%CI 1.0-2.3; p=0.03). These results remained significant also in multivariable analysis adjusting for the other 8 PHQ-9 items. Conclusion: Eating disorders with reduced or absent appetite or overeating represent powerful prognostic indicators regarding all-cause mortalityrisk in patients with CHF hospitalized for cardiac decompensation.
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