Abstract
Background and aim: Heart failure (HF) is a clinical syndrome associated with poor quality of life and prognosis, and premature mortality. The aim of this study was to assess the prevalence of depression and its risk factors in HF patients. Methods: The study included 151 HF patients (mean age of 66.6 ± 11 years, 52.3% female). Based on ejection fraction (EF), the study cohort was divided into the following two groups: group-I: HFpEF patients (EF ≥ 50%, n = 47) and group-II: HFrEF patients (EF < 40%, n = 104). For the enrolled patients, demographic, clinic and echocardiographic indices, and depression scale results were collected. Results: The patients with HF and depression were older, mostly females, more obese, and had a higher glycemic level and higher NYHA functional class compared with the patients without depression (p < 0.05 for all). The left ventricle (LV) and left atrial (LA) dimensions were larger, and EF was lower, in patients with depression compared to those without depression (p < 0.05 for all), while the right ventricle (RV) measurements did not differ (p > 0.05). The same parameters remained significantly different when the patients were divided into HFpEF and HFrEF. The depression scale correlated with glycemic level (r = 0.51, p = 0.01), obesity (rpb = 0.53, p = 0.001), age (r = 0.47, p = 0.02), and severity of NYHA class (rpb = 0.54, p = 0.001). On a multivariate model, BMI ≥ 30 kg/m2, OR 1.890 (1.199 to 3.551; 0.02) glycemic level ≥ 8.5 mmol/L, OR 2.802 (1.709 to 5.077; p = 0.01), and NYHA class > 2, OR 2.103 (1.389 to 4.700; p = 0.01), proved to be the most powerful independent predictors of depression, in the group as a whole. Obesity and uncontrolled diabetes predicted depression, irrespective of EF. Conclusions: In this modest cohort of HF patients, obesity and uncontrolled diabetes were independent predictors of depression, irrespective of LV systolic function. This emphasizes the important role of medical education for better control of such risk factors.
Highlights
It has been suggested that Heart failure (HF) itself could have a causal relationship with the onset of depression, since some parts of the brain are especially vulnerable to suboptimal perfusion, especially with reduced cardiac output and underlying cerebral atherosclerosis [4]
One hundred and fifty-one patients were included in the study, with a mean LV ejection fraction (LVEF) of 47 ± 7.8% and New York Heart Association (NYHA) functional class of 2.3 ± 1.0
Obesity, uncontrolled diabetes, and NYHA class were independent predictors of depression in the HFrEF patients, while female gender, obesity, and uncontrolled diabetes were the respective predictors in the HFpEF group
Summary
Heart failure (HF) is a known clinical syndrome and constitutes a major public health problem associated with poor quality of life and prognosis, and premature mortality [1]. It is well established that depression is an independent risk factor for HF due to coronary artery disease and other cardiac diseases [2], and symptoms of depression are associated with a greater risk of adverse cardiac events [3]. It has been suggested that HF itself could have a causal relationship with the onset of depression, since some parts of the brain are especially vulnerable to suboptimal perfusion, especially with reduced cardiac output and underlying cerebral atherosclerosis [4]. The classical hypothesis supports a link between the onset of depression and suffering from chronic stress in patients with chronic heart disease [5]
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