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Could Depression Raise Heart Failure Patients’ Death Rate? Depression is a feeling of sad when people encounter disappointments in life, for instance, when they face a difficult life situation or they lost someone they loved. Most people will just get over it after some time when they learn to overcome the problems or accept changes in their lives. But for some, the depression can become so severe that it can affect their thoughts, behavior, feelings and sense of well-being. These people can not only feel sad, but also become anxious, empty, hopeless, helpless, worthless, guilty, irritable, ashamed or restless. It can then become a medical condition that require treatment. While previous study has shown that depression is linked to death in patients with heart failure, it was thought that this could be due to the fact that depressed patients have more severe heart failure and more comorbidities. Comorbidity refers to the simultaneous presence of two chronic diseases or conditions in a patient. A recent study that was reported at the annual meeting of the Heart Failure Association of the European Society of Cardiology in May 2015 in Seville, Spain indicated that depression could actually raise the risk of death among people with heart failure. The study, which were conducted by researchers from the Imperial College London, included 154 patients hospitalized with heart failure. Using Hospital Anxiety and Depression Scale to measure symptoms of depression, the researchers found that 103 patients were not depressed, 27 had mild depression, and 24 had moderate to severe depression. During the follow-up of 302 days on average, there were 27 deaths. Participants with moderate to severe depression had a 5 times higher risk of death than those with no or mild depression. The relationship remained after sex, age, high blood pressure, severity of heart failure, and comorbidities were taken into account. Individuals with a low depression score had an 80 percent lower risk of death. Depression has been found to be strongly related to death during the year following discharge from hospital after an admission for the exacerbation of heart failure and the link is expected to persist beyond one year. The association was independent of the severity of heart failure or the presence of comorbidities.
The findings, which were also published on June 19, 2015 in journal ‘PLoS One’, showed that about 25 percent of the patients hospitalized with heart failure are readmitted for a variety of reasons within one month, and most patients will have had one or more readmissions and almost half will have died within a year. The study, however, did not prove definitively that depression causes an increase in death risk among heart failure patients. It has been known that patients with heart failure are at a higher risk of recurrent hospital admissions and death. Meanwhile, depression is also found between 20 and 40 percent of heart failure. According to researchers, the link they found between depression and mortality is probably due to the fact that people with depression often have no motivation, lower quality of life, no confidence and sleep disturbance, and they also lose interest in everyday activities and change in appetite with corresponding weight change. While doctors should screen patients with heart failure for depression, they should not immediately prescribe them with antidepressants, cautioned by the researchers. This is because studies have suggested that antidepressants are not effective in dealing with depression in patients with heart failure. Instead, doctors should consider referring these patients for counseling. Recognition and management of depression might lower mortality for patients with heart failure. More importantly, further studies should be carried out to investigate the way doctors and patients can do to manage depression, and hopefully to devise better treatments for heart failure, comorbidities as well as depression itself.
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