Abstract P153: Depressive Symptoms and First Hospitalization for Heart Failure: Findings From the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Abstract

Introduction: Depressive symptoms are independently associated with cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke. It is unclear whether depressive symptoms are associated with first heart failure (HF) hospitalization and whether this relationship differs by ejection fraction (EF). We hypothesized that depressive symptoms are associated with increased risk of first HF hospitalization among community dwelling adults free of HF or coronary heart disease at baseline, and that this relationship would be similar by EF. Methods: We examined this relationship in the REGARDS study, a prospective longitudinal cohort of community dwelling adults aged ≥45 years (55% women, 41% black) from across the continental US, with oversampling of blacks and residents of the Southeast. Participants completed a baseline survey on medical history and health behaviors, and an in-home visit which collected physiologic parameters, blood and urine samples, ECG, and medication inventory. Participants are followed prospectively and hospital records are collected for CVD-related hospitalizations. Depressive symptoms were defined as score ≥4 on the 4-item Center for Epidemiologic Studies Depression scale (CES-D-4). HF hospitalizations were expert adjudicated and specified according to EF as preserved EF (EF >40%) (HFpEF) or reduced EF (EF≤ 40%) (HFrEF). Results: Over a median [IQR] of 9.3 [6.4-11] years of follow-up, there were 614 first HF hospitalizations among 22,465 individuals (384 HFpEF, 230 HFrEF). Participants with depressive symptoms had less education and lower annual income. The age-adjusted first HF hospitalization incidence rates per 1000 person-years were 4.6 (95% CI, 3.2-4.0) for participants with depressive symptoms versus 2.6 (95% CI, 2.3-2.8) for non-depressed, p 0.0002. This elevated risk remained significant after controlling for a host CVD risk factors. When HFpEF was assessed separately, depressive symptoms were associated with increased risk of hospitalization after controlling for all covariates (hazard ratio [HR] 1.54, 95% CI 1.06-2.22). In contrast, depressive symptoms were not associated with first HFrEF hospitalization in both unadjusted and adjusted analyses. Conclusions: Depressive symptoms at baseline were independently associated with future risk of first hospitalization for HFpEF but not for HFrEF.