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We read with interest the article by Sullivan et al¹ on depression-related costs in heart failure care. In our previous data published in the ARCHIVES regarding the rate of hospitalization in patients with heart failure with or without depression,² we found a higher risk not only for mortality but also for health services use (ie, rehospitalization) in the first group compared with the second group.

The direct association between depression and negative outcomes in patients with somatic diseases supports the importance of performing intervention studies with antidepressants. Previous and recent data suggest a positive role of depression treatment in modifying relevant clinical outcomes.³

The problem is to understand if depression is a comorbidity, the clinical relevance of which could be unmasked or increased by the somatic event, or a psychic symptom marker of frailty revealing the lack of competence toward a distressful event. In the first case the treatment could . . . [Full Text of this Article]

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