Depressive Symptoms Have a Role in the Relationship between Inflammation and Physical Symptoms in Patients with Heart Failure

Abstract

Background: Patients with heart failure (HF) often have physical symptoms that result in poor health-related quality of life (HRQOL) and are antecedents of hospitalizations. Inflammation can produce symptoms as part of the pathological response in HF. Depressive symptoms can affect the relationships between inflammation and physical symptoms. Purpose: To examine the relationships between inflammation (soluble tumor necrosis factor receptor 1 [sTNF-R1]) and physical symptoms and the role of depressive symptoms on the relationship in patients with HF, controlling for relevant covariates (i.e., age, body mass index [BMI], social support, comorbidities, and medication). Methods: A total of 145 patients with HF (age 60612 years, 68% male, 51% NYHA class III/IIV) participated. Data on physical symptoms (Symptom Status Questionnaire-Heart Failure) and depressive symptoms (Beck Depression Inventory [BDI]-II) were collected. Data on sTNF-R1 were collected using blood samples and were root transformed to achieve normality. Patients were divided into two subgroups based on the score of the BDI-II (non-depressed: ! 14 vs. depressed: $ 14). Hierarchical multiple regression models were used to analyze the data. Results: sTNF-R1 was significantly related to physical symptoms, controlling for covariates (F 5 9.215, p ! .001). sTNF-R1 was significantly related to physical symptoms only in the non-depressed subgroup, controlling for covariates (F 5 3.738, p 5 .002). Among the covariates, social support and BMI were significantly related to physical symptoms in the total sample and in the two subgroups. Conclusion: sTNF-R1 may be used as an objective indicator of physical symptoms in patients with HF. Depressive symptoms have a role in the relationships between inflammation and physical symptoms in patients with HF.