Depression, Healthcare Utilization, and Death in Heart Failure: A Community Study
Background—The increasing prevalence of heart failure (HF) and high associated costs have spurred investigation of factors leading to adverse outcomes in HF patients. Studies to date report inconsistent evidence regarding the link between depression and outcomes with only limited data on emergency department (ED) and outpatient visits.
Methods and Results—Olmsted, Dodge, and Fillmore county, MN residents with HF were prospectively recruited between October 2007 and December 2010, and completed a one-time 9-item Patient Health Questionnaire (PHQ-9) for depression categorized as: none-minimal (PHQ-9 score 0-4), mild (5-9), or moderate-severe (≥10). Andersen-Gill models were used to determine if depression predicted hospitalizations and ED visits while negative binomial regression models explored the association of depression with outpatient visits. Cox proportional hazards regression characterized the relationship between depression and all-cause mortality. Among 402 HF patients (mean age 73±13, 58% male), 15% had moderate-severe depression, 26% mild, and 59% none-minimal. Over a mean follow-up of 1.6 years, 781 hospitalizations, 1000 ED visits, 15,515 outpatient visits, and 74 deaths occurred. After adjustment, moderate-severe depression was associated with nearly a 2-fold increased risk of hospitalization (HR 1.79, 95% CI 1.30-2.47) and ED visits (HR 1.83, 95% CI 1.34-2.50), a modest increase in outpatient visits (RR 1.20, 95% CI 1.00-1.45), and a 4-fold increase in all-cause mortality (HR 4.06, 95% CI 2.35-7.01).
Conclusions—In this prospective cohort study, depression independently predicted an increase in the use of healthcare resources and mortality. Greater recognition and management of depression in HF may optimize clinical outcomes and resource utilization.
- Received September 21, 2012.
- Accepted February 15, 2013.