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Wei Jiang, MD; Jude Alexander, MD; Eric Christopher, MD; Maragatha Kuchibhatla, PhD; Laura H. Gaulden, NP; Michael S. Cuffe, MD; Michael A. Blazing, MD; Charles Davenport; Robert M. Califf, MD; Ranga R. Krishnan, MD; Christopher M. O'Connor, MD

Arch Intern Med. 2001;161:1849-1856.

Background  Patients with congestive heart failure (CHF) may have a high prevalence of depression, which may increase the risk of adverse outcomes.

Objective  To determine the prevalence and relationship of depression to outcomes of patients hospitalized with CHF.

Methods  We screened patients aged 18 years or older having New York Heart Association class II or greater CHF, an ejection fraction of 35% or less, or both, admitted between March 1, 1997, and June 30, 1998, to the cardiology service of one hospital. Patients with a Beck Depression Inventory score of 10 or higher underwent a modified National Institute of Mental Health Diagnostic Interview Schedule to identify major depressive disorder. Primary care providers coordinated standard treatment for CHF and other medical and psychiatric disorders. We assessed all-cause mortality and readmission (rehospitalization) rates 3 months and 1 year after depression assessment. Logistic regression analyses were used to evaluate the independent prognostic value of depression after adjustment for clinical risk factors.

Results  Of 374 patients screened, 35.3% had a Beck Depression Inventory score of 10 or higher and 13.9% had major depressive disorder. Overall mortality was 7.9% at 3 months and 16.2% at 1 year. Major depression was associated with increased mortality at 3 months (odds ratio, 2.5 vs no depression; P = .08) and at 1 year (odds ratio, 2.23; P = .04) and readmission at 3 months (odds ratio, 1.90; P = .04) and at 1 year (odds ratio, 3.07; P = .005). These increased risks were independent of age, New York Heart Association class, baseline ejection fraction, and ischemic etiology of CHF.

Conclusions  Major depression is common in patients hospitalized with CHF and is independently associated with a poor prognosis.

From the Departments of Psychiatry (Drs Jiang, Alexander, Christopher, and Krishnan and Mr Davenport) and Medicine (Drs Cuffe, Blazing, Califf, and O'Connor and Ms Gaulden) and the Division of Biometry (Dr Kuchibhatla), Department of Community and Family Medicine, Duke University Medical Center, Durham, NC.

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