Elevated Depression Symptoms Predict Long-Term Cardiovascular Mortality in Patients With Atrial Fibrillation and Heart Failure

Frasure-Smith, Nancy; Lespérance, François; Habra, Martine E.; Talajic, Mario; Khairy, Paul; Dorian, Paul; Roy, Denis

doi:10.1161/circulationaha.109.851675

Cited by 209 publications

(149 citation statements)

References 45 publications

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“…Not only does the incidence of depression increase with the presence of HF, but it is also related to its severity, being more frequent in more symptomatic HF 11,12,19 . Thus, the frequency of depressive disorders is higher among cohorts of hospitalized patients than among outpatients, probably as a reflex of the greater severity of HF in hospitalized patients [6][7][8][9][10][11][12][13]19 . Mild depression may be found in most of the patients hospitalized for cardiac decompensation, affecting 85.0% of them.…”

Section: Discussionmentioning

confidence: 98%

“…The loss of social support is identified as one of the most important factors for depression, increasing its risk by 3.2 times in men and 8 times in women 18 . Depression has not been systematically analyzed in patients with HF, but, when studied, it is verified to be relatively common among these patients [6][7][8][9][10][11][12][13] . In patients without HF, major depressive manifestations are described in 14.0%-26.0% of the individuals; however, in patients with HF, this incidence rises to 24.0%-85.0% of the patients 4 .…”

Section: Discussionmentioning

confidence: 99%

“…The wide variation in the incidence results from the different techniques used for the diagnosis, as well as from the characteristics of the study populations, considering age, gender and severity of HF 5 . Anyway, a strong association between HF and depression is observed [6][7][8][9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 98%

“…Depression can contribute to the development of HF in susceptible populations and aggravate the manifestations of HF in those with existing disease, and is predictive of rehospitalizations and mortality 6,7,10,11 .…”

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confidence: 99%

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Relação entre depressão, nível de BNP e comprometimento ventricular na insuficiência cardíaca

Aguiar¹,

Ochiai²,

Cardoso³

et al. 2010

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

mentioning

confidence: 99%

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Relação entre depressão, nível de BNP e comprometimento ventricular na insuficiência cardíaca

Aguiar¹,

Ochiai²,

Cardoso³

et al. 2010

Arq. Bras. Cardiol.

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“…Mood disorders are also important in subjects with arrhythmia. In fact, the presence of depressive symptoms predicted cardiovascular and all-cause mortality in the AF-CHF trial patients, with adjusted hazard ratios of 1.57 (95% CI: 1.20-2.07) and 1.38 (95% CI: 1.07-1.77), respectively [10]. However, the most fascinating aspect related to AF in the elderly is the association between the arrhythmia and cognitive decline.…”

Section: Priority Paper Evaluation -Fumagalli Tarantini and Marchionnimentioning

confidence: 99%

Atrial Fibrillation: Still a Benign Condition in the Elderly?

2010

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Evaluation of: Vesin C, Protogerou AD, Lieber A et al.: Predictive factors for all-cause mortality in the hospitalized elderly subject: the importance of arrhythmia. Atherosclerosis 207, 507–513 (2009). A recent study demonstrated that the presence of an atrial arrhythmia, mainly atrial fibrillation, in a hospitalized elderly population (mean age: 85 years) was an independent predictor of all-cause mortality during follow-up. This association persisted in multivariable analyses, even after adjustment for several social, clinical and laboratory variables. The great complexity of a ‘real-world’ geriatric population, which is the result of the coexistence of comorbidities, mood disorders, poor social networks and reduced homeostasis, may explain these results. New age-oriented guidelines are necessary in order to effectively manage atrial fibrillation in elderly individuals who are most exposed to the severe complications of arrhythmia.

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Efficacy of Blended Collaborative Care for Patients With Heart Failure and Comorbid Depression

et al. 2021

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IMPORTANCE Depression is often comorbid in patients with heart failure (HF) and is associated with worse clinical outcomes. However, depression generally goes unrecognized and untreated in this population.OBJECTIVE To determine whether a blended collaborative care program for treating both HF and depression can improve clinical outcomes more than collaborative care for HF only and physicians' usual care (UC). DESIGN, SETTING, AND PARTICIPANTSThis 3-arm, single-blind, randomized effectiveness trial recruited 756 participants with HF with reduced left ventricular ejection fraction (<45%) from 8 university-based and community hospitals in southwestern Pennsylvania between March 2014 and October 2017 and observed them until November 2018. Participants included 629 who screened positive for depression during hospitalization and 2 weeks postdischarge and 127 randomly sampled participants without depression to facilitate further comparisons. Key analyses were performed November 2018 to March 2019. INTERVENTIONS Separate physician-supervised nurse teams provided either 12 months of collaborative care for HF and depression ("blended" care) or collaborative care for HF only (enhanced UC [eUC]). MAIN OUTCOMES AND MEASURES The primary outcome was mental health-related quality of life (mHRQOL) as measured by the Mental Component Summary of the 12-item Short Form Health Survey (MCS-12). Secondary outcomes included mood, physical function, HF pharmacotherapy use, rehospitalizations, and mortality. RESULTS Of the 756 participants (mean [SD] age, 64.0 [13.0] years; 425 [56%] male), those with depression reported worse mHRQOL, mood, and physical function but were otherwise similar to those without depression (eg, mean left ventricular ejection fraction, 28%). At 12 months, blended care participants reported a 4.47-point improvement on the MCS-12 vs UC (95% CI, 1.65 to 7.28; P = .002), but similar scores as the eUC arm (1.12; 95% CI, −1.15 to 3.40; P = .33). Blended care participants also reported better mood than UC participants (Patient-Reported Outcomes Measurement Information System-Depression effect size, 0.47; 95% CI, 0.28 to 0.67) and eUC participants (0.24; 95% CI, 0.07 to 0.41), but physical function, HF pharmacotherapy use, rehospitalizations, and mortality were similar by both baseline depression and randomization status. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial of patients with HF and depression, telephone-delivered blended collaborative care produced modest improvements in mHRQOL, the primary outcome, on the MCS-12 vs UC but not eUC. Although blended care did not differentially affect rehospitalization and mortality, it improved mood better than eUC and UC and thus may enable organized health care systems to provide effective first-line depression care to medically complex patients.

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Elevated Depression Symptoms Predict Long-Term Cardiovascular Mortality in Patients With Atrial Fibrillation and Heart Failure

Cited by 209 publications

References 45 publications

Relação entre depressão, nível de BNP e comprometimento ventricular na insuficiência cardíaca

Relação entre depressão, nível de BNP e comprometimento ventricular na insuficiência cardíaca

Atrial Fibrillation: Still a Benign Condition in the Elderly?

Efficacy of Blended Collaborative Care for Patients With Heart Failure and Comorbid Depression

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