Symptom patterns and clinical outcomes in women versus men with systolic heart failure and depression
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Depression is more common in females than in males and is 3–5 times more prevalent in patients with heart failure (HF) than in the general population. The 9-item Patient Health Questionnaire (PHQ-9) is a validated depression screening instrument; higher sum-scores predict adverse clinical outcomes. Sex- and gender differences in PHQ-9 symptom profile, diagnostic and prognostic properties, and impact on health-related quality of life (HRQOL) have not been comprehensively studied in HF patients.
Methods and results
This post hoc analysis from the Interdisciplinary Network Heart Failure program enrolled 852/1022 participants (67 ± 13 years, 28% female) who completed the PHQ-9 at hospital discharge after cardiac decompensation. All had a left ventricular ejection fraction ≤ 40%. Women had a higher mean PHQ-9 sum-score than men (8.4 ± 5.6 vs. 7.4 ± 5.5; p = 0.027), and higher proportions rated the following items ≥ 2 (i.e., present on ≥ 50% of days): ‘feeling down, hopeless’ (25.8 vs. 18.0%; p = 0.011); ‘fatigue’ (51.9 vs. 37.2%; p < 0.001); and ‘trouble concentrating’ (21.6 vs. 15.4%; p = 0.032). A PHQ-9 sum-score ≥ 10 predicted increased mortality in women [hazard ratio 1.91 (95% confidence interval 1.06–3.43); p = 0.030] and men [2.10 (1.43–3.09); p < 0.001] and was associated with worse HRQOL (p < 0.001 for all comparisons). Sum-scores ≥ 10 predicted higher re-hospitalization rates in men only [1.35 (1.08–1.69); p = 0.008].
Differences in several PHQ-9 items indicated sex- or gender-specific depression symptomatology in HF. For both sexes, HRQOL and survival were worse when PHQ-9 sum-score was ≥ 10, but higher sum-scores predicted higher re-hospitalization rates in men only. Considering these specific aspects might help optimize care strategies in HF.
KeywordsHeart failure Depression Sex Mortality Morbidity
English language editing assistance was provided by Nicola Ryan, BSc, independent medical writer.
This study was funded by the Federal Ministry of Education and Research (BMBF), Grant 01GL0304, by the Competence Network Heart Failure Germany (grants 01GI0205 and 01GI1202A), and by the Comprehensive Heart Failure Center Würzburg (Grants 01EO1004 and 01EO1504).
Compliance with ethical standards
Conflict of interest
None of the authors report any conflicts of interest, including any financial relationship with industry, relevant to this manuscript.
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