Advertisement

Heart Failure Reviews

, Volume 21, Issue 1, pp 49–63 | Cite as

Depression and anxiety as predictors of mortality among heart failure patients: systematic review and meta-analysis

  • I. Sokoreli
  • J. J. G. de Vries
  • S. C. Pauws
  • E. W. Steyerberg
Article

Abstract

Several studies suggest that psychological factors are associated with negative outcomes and in particular higher mortality rates among heart failure (HF) patients. We aimed to evaluate the effect sizes of depression and anxiety on all-cause mortality in HF patients. We conducted a systematic review according to the PRISMA methodology. We searched for studies on depression or anxiety effects on all-cause mortality among HF patients published up to June 2015. A number of 26 and 6 articles met inclusion criteria for depression (total 80,627 patients) and anxiety (total 17,214 patients), respectively. The effect estimates were pooled using random-effect meta-analysis. Depression has significant and moderately heterogeneous effect on all-cause mortality (HR = 1.57; 95 %CI 1.30–1.89, p < 0.001); adjustment for confounders led to a similar effect estimate (HR = 1.40; 95 %CI 1.22–1.60; p < 0.001). Larger studies and higher study prevalence of depression were associated with smaller effect size. The effect of anxiety on mortality outcome was small and not conclusive given the low number of studies (n = 6) (HR = 1.02; 95 % CI 1.00–1.04, p < 0.05). This systematic review and meta-analysis suggests that depression is an important and independent predictor of all-cause mortality among HF patients, while anxiety does not appear to have a strong effect. Further research is recommended toward the detection and treatment of depression.

Keywords

Heart failure Depression Anxiety Mortality Systematic review Meta-analysis 

Notes

Acknowledgments

The authors would like to thank John Dielis from E-Science & Information Management Department, Philips, Eindhoven, for contributing in querying the databases.

Funding

IS, JJGV and SCP are employed by Philips Research.

Compliance with ethical standards

Conflict of interest

EWS has no conflict of interest to declare.

References

  1. 1.
    Mcmurray JJV, Adamopoulos S, Anker SD et al (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur J Heart Fail 14:803–869. doi: 10.1093/eurjhf/hfs105 PubMedCrossRefGoogle Scholar
  2. 2.
    Mosterd A, Hoes AW (2007) Clinical epidemiology of heart failure. Heart 93:1137–1146. doi: 10.1136/hrt.2003.025270 PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Ladwig K-H, Lederbogen F, Albus C et al (2014) Position paper on the importance of psychosocial factors in cardiology: update 2013. Ger Med Sci. doi: 10.3205/000194 PubMedPubMedCentralGoogle Scholar
  4. 4.
    Rutledge T, Reis VA, Linke SE et al (2006) Depression in heart failure. A meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol 48:1527–1537. doi: 10.1016/j.jacc.2006.06.055 PubMedCrossRefGoogle Scholar
  5. 5.
    Konstam V, Moser DK, De Jong MJ (2005) Depression and anxiety in heart failure. J Card Fail 11:455–463. doi: 10.1016/j.cardfail.2005.03.006 PubMedCrossRefGoogle Scholar
  6. 6.
    Fan H, Yu W, Zhang Q et al (2014) Depression after heart failure and risk of cardiovascular and all-cause mortality: a meta-analysis. Prev Med (Baltim) 63:36–42. doi: 10.1016/j.ypmed.2014.03.007 CrossRefGoogle Scholar
  7. 7.
    Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. doi: 10.1371/journal.pmed.1000100 Google Scholar
  8. 8.
    Higgins JPT, Altman DG, Gøtzsche PC, et al. (2011) The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 343:d5928. doi: 10.1136/bmj.d5928 CrossRefGoogle Scholar
  9. 9.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ Br Med J 327:557–560. doi: 10.1136/bmj.327.7414.557 CrossRefGoogle Scholar
  10. 10.
    Zich JM, Attkisson CC, Greenfield TK (1990) Screening for depression in primary care clinics: the CES-D and the BDI. Int J Psychiatry Med 20:259–277PubMedCrossRefGoogle Scholar
  11. 11.
    Kroenke K, Spitzer RL, Williams JBW (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613. doi: 10.1046/j.1525-1497.2001.016009606.x PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Ioannidis JPA (2005) Contradicted and initially stronger effects in highly cited clinical research. JAMA J Am Med Assoc 294:218–228. doi: 10.1001/jama.294.2.218 CrossRefGoogle Scholar
  13. 13.
    Evans I, Thornton H, Chalmers I (2008) Testing treatments: better research for better healthcare. Chin J Evid-Based Med. doi: 10.1136/bmj.332.7556.1516 Google Scholar
  14. 14.
    Mushlin AI, Ghomrawi H (2010) Health care reform and the need for comparative-effectiveness research. N Engl J Med 362:e6. doi: 10.1056/NEJMp0912651 PubMedCrossRefGoogle Scholar
  15. 15.
    Adams J, Kuchibhatla M, Christopher EJ et al (2012) Association of depression and survival in patients with chronic heart failure over 12 years. Psychosomatics 53:339–346. doi: 10.1016/j.psym.2011.12.002 PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Albert NM, Fonarow GC, Abraham WT et al (2009) Depression and clinical outcomes in heart failure: an OPTIMIZE-HF analysis. Am J Med 122:366–373. doi: 10.1016/j.amjmed.2008.09.046 PubMedCrossRefGoogle Scholar
  17. 17.
    Diez-Quevedo C, Lupón J, González B et al (2013) Depression, antidepressants, and long-term mortality in heart failure. Int J Cardiol 167:1217–1225. doi: 10.1016/j.ijcard.2012.03.143 PubMedCrossRefGoogle Scholar
  18. 18.
    Faller H, Störk S, Schowalter M et al (2007) Depression and survival in chronic heart failure: does gender play a role? Eur J Heart Fail 9:1018–1023. doi: 10.1016/j.ejheart.2007.06.011 PubMedCrossRefGoogle Scholar
  19. 19.
    Faller H, Störk S, Gelbrich G et al (2015) Depressive symptoms in heart failure: independent prognostic factor or marker of functional status? J Psychosom Res. doi: 10.1016/j.jpsychores.2015.02.015 PubMedGoogle Scholar
  20. 20.
    Farisa R, Purcell H, Henein MY, Coats AJS (2002) Clinical depression is common and significantly associated with reduced survival in patients with non-ischaemic heart failure. Eur J Heart Fail 4:541–551. doi: 10.1016/S1388-9842(02)00101-0 CrossRefGoogle Scholar
  21. 21.
    Friedmann E, Thomas SA, Liu F et al (2006) Relationship of depression, anxiety, and social isolation to chronic heart failure outpatient mortality. Am Heart J 152:1–8. doi: 10.1016/j.ahj.2006.05.009 CrossRefGoogle Scholar
  22. 22.
    Jiang W, Alexander J, Christopher E et al (2001) Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med 161:1849–1856. doi: 10.1001/archinte.161.15.1849 PubMedCrossRefGoogle Scholar
  23. 23.
    Jiang W, Kuchibhatla M, Clary GL et al (2007) Relationship between depressive symptoms and long-term mortality in patients with heart failure. Am Heart J 154:102–108. doi: 10.1016/j.ahj.2007.03.043 PubMedCrossRefGoogle Scholar
  24. 24.
    Jünger J, Schellberg D, Müller-Tasch T et al (2005) Depression increasingly predicts mortality in the course of congestive heart failure. Eur J Heart Fail 7:261–267. doi: 10.1016/j.ejheart.2004.05.011 PubMedCrossRefGoogle Scholar
  25. 25.
    Kato N, Kinugawa K, Yao A et al (2009) Relationship of depressive symptoms with hospitalization and death in Japanese patients with heart failure. J Card Fail 15:912–919. doi: 10.1016/j.cardfail.2009.06.442 PubMedCrossRefGoogle Scholar
  26. 26.
    Lesman-Leegte I, Van Veldhuisen DJ, Hillege HL et al (2009) Depressive symptoms and outcomes in patients with heart failure: data from the COACH study. Eur J Heart Fail 11:1202–1207. doi: 10.1093/eurjhf/hfp155 PubMedCrossRefGoogle Scholar
  27. 27.
    Moraska AR, Chamberlain AM, Shah ND et al (2013) Depression, healthcare utilization, and death in heart failure a community study. Circ Heart Fail 6:387–394. doi: 10.1161/CIRCHEARTFAILURE.112.000118 PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    O’Connor CM, Abraham WT, Albert NM et al (2008) Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the organized program to initiate lifesaving treatment in hospitalized patients with heart failure (OPTIMIZE-HF). Am Heart J 156:662–673. doi: 10.1016/j.ahj.2008.04.030 PubMedCrossRefGoogle Scholar
  29. 29.
    Sullivan MD, Levy WC, Crane BA et al (2004) Usefulness of depression to predict time to combined end point of transplant or death for outpatients with advanced heart failure. Am J Cardiol 94:1577–1580. doi: 10.1016/j.amjcard.2004.08.046 PubMedCrossRefGoogle Scholar
  30. 30.
    Alhurani AS, Dekker RL, Abed MA et al (2014) The association of co-morbid symptoms of depression and anxiety with all-cause mortality and cardiac rehospitalization in patients with heart failure. Psychosomatics 56:371–380. doi: 10.1016/j.psym.2014.05.022 PubMedCrossRefGoogle Scholar
  31. 31.
    Coyne JC, Rohrbaugh MJ, Shoham V et al (2001) Prognostic importance of marital quality for survival of congestive heart failure. Am J Cardiol 88:526–529. doi: 10.1016/S0002-9149(01)01731-3 PubMedCrossRefGoogle Scholar
  32. 32.
    Cully JA, Johnson M, Moffett ML et al (2009) Depression and anxiety in ambulatory patients with heart failure. Psychosomatics 50:592–598. doi: 10.1176/appi.psy.50.6.592 PubMedCrossRefGoogle Scholar
  33. 33.
    Konstam V, Salem D, Pouleur H et al (1996) Baseline quality of life as a predictor of mortality and hospitalization in 5025 patients with congestive heart failure. Am J Cardiol 78:890–895. doi: 10.1016/S0002-9149(96)00463-8 PubMedCrossRefGoogle Scholar
  34. 34.
    Murberg TA, Bru E (2001) Social relationships and mortality in patients with congestive heart failure. J Psychosom Res 51:521–527PubMedCrossRefGoogle Scholar
  35. 35.
    Rollman BL, Herbeck Belnap B, Mazumdar S et al (2012) A positive 2-item patient health questionnaire depression screen among hospitalized heart failure patients is associated with elevated 12-month mortality. J Card Fail 18:238–245. doi: 10.1016/j.cardfail.2011.11.002 PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Sherwood A, Blumenthal JA, Trivedi R et al (2007) Relationship of depression to death or hospitalization in patients with heart failure. Arch Intern Med 167:367–373. doi: 10.1001/archinte.167.4.367 PubMedCrossRefGoogle Scholar
  37. 37.
    Smith ORF, Kupper N, Schiffer AA, Denollet J (2012) Somatic depression predicts mortality in chronic heart failure: can this be explained by covarying symptoms of fatigue? Psychosom Med 74:459–463. doi: 10.1097/PSY.0b013e31824ef2f4 PubMedCrossRefGoogle Scholar
  38. 38.
    Van Den Broek KC, Defilippi CR, Christenson RH et al (2011) Predictive value of depressive symptoms and B-type natriuretic peptide for new-onset heart failure and mortality. Am J Cardiol 107:723–729. doi: 10.1016/j.amjcard.2010.10.055 PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Volz A, Schmid J-P, Zwahlen M et al (2011) Predictors of readmission and health related quality of life in patients with chronic heart failure: a comparison of different psychosocial aspects. J Behav Med 34:13–22. doi: 10.1007/s10865-010-9282-8 PubMedCrossRefGoogle Scholar
  40. 40.
    Zuluaga MC, Guallar-Castillón P, Rodríguez-Pascual C et al (2010) Mechanisms of the association between depressive symptoms and long-term mortality in heart failure. Am Heart J 159:231–237. doi: 10.1016/j.ahj.2009.11.011 PubMedCrossRefGoogle Scholar
  41. 41.
    Jiang W, Kuchibhatla M, Cuffe MS et al (2004) Prognostic value of anxiety and depression in patients with chronic heart failure. Circulation 110:3452–3456. doi: 10.1161/01.CIR.0000148138.25157.F9 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • I. Sokoreli
    • 1
  • J. J. G. de Vries
    • 1
  • S. C. Pauws
    • 1
  • E. W. Steyerberg
    • 2
  1. 1.Philips Research - HealthcareEindhovenThe Netherlands
  2. 2.Department of Public Health, Centre for Medical Decision MakingErasmus MCRotterdamThe Netherlands

Personalised recommendations