Depression is a major issue in heart failure (HF). Depression is present in about one in five HF patients, with about 48 % of these individuals having significant depression. There is a wide variation in reported prevalences because of differences in the cohorts studied and methodologies. There are shared pathophysiological mechanisms between HF and depression. The adverse effects of depression on the outcomes in HF include reduced quality of life, reduced healthcare use, rehospitalisation and increased mortality. Results from metaanalysis suggest a twofold increase in mortality in HF patients with compared to those without depression. Pharmacological management of depression in HF has not been shown to improve major outcomes. No demonstrable benefits over cognitive behavioural therapy and psychotherapy have been demonstrated.

Background: Heart failure (HF) is a common, chronic clinical syndrome with appreciable impact on both prognosis and lifestyle of patients. Two main aims of management include preventing disease progression and improving quality of life (QoL). Not much work has been done in this area in Sub-Saharan Africa and most of the available disease specific instruments were developed using the Caucasian population. Aim: We therefore evaluated the QoL of stable HF patients attending the cardiology clinic of the Lagos University Teaching Hospital using a disease specific instrument, Kansas City Cardiomyopathy Questionnaire (KCCQ) and a generic one, the WHOQOL- BREF. Method: Consenting, stable HF patient were recruited from the cardiology clinic of the Lagos University Teaching Hospital. Relevant clinical data and echocardiographic parameters were retrieved from their clinical notes and the subjects filled out the questionnaires, the KCCQ and the WHOQOL-BREF. The QoL and four main domains in the WHOQOL- BREF were compared with scores on the KCCQ for relationships. Result: Data set of 190 patients was analysed. There were 91 (47.9%) males and 99 (52.1%) females with a mean age 51.90 ± 13.21 yrs. Only 52 (27.4%) had college education and 143 (75.2%) had very poor personal resources. About 104 (54.7%) were paying their medical bills themselves. The mean QoL score using the KCCQ score was 59.61 ± 23.80. With The KCCQ, 6.9% felt their QoL was poor and 20% felt it was fair while 11.6% and 20.5% felt their QoL was poor and fair respectively with the WHOQOL-BREF. There was positive correlation, p < 0.0001, between the KCCQ QoL and WHO-BREF QoL scores and the four domains assessed; physical health, psychological, social relationships, environment. Conclusion: Over 25% of HF patients in our environment have unacceptable levels of quality of life which has to be addressed in their management. The generic WHOQOL-BREF would suffice in our environment if the specific HFQoL instruments are not available.

This study assessed the prevalence and pattern of suicidality and its relationship with certain sociodemographic and clinical variables.

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