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Depression worsens outcomes in elderly patients with heart failure: An analysis of 48,117 patients in a community setting
Author(s) -
Macchia Alejandro,
Monte Simona,
Pellegrini Fabio,
Romero Marilena,
D'Ettorre Antonio,
Tavazzi Luigi,
Togi Gianni,
Maggioni Aldo P.
Publication year - 2008
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2008.05.011
Subject(s) - medicine , heart failure , depression (economics) , confounding , propensity score matching , digoxin , atrial fibrillation , stroke (engine) , medical prescription , proportional hazards model , carvedilol , mechanical engineering , engineering , economics , pharmacology , macroeconomics
Abstract Aims To assess the relationship between depression and clinical outcomes among elderly patients with heart failure (HF) in a community setting. Methods and results To identify patients with HF and depression we used record linkage analysis of hospital discharge records, prescription databases and vital statistics. All consecutive patients aged ≥ 60 years in 6 Local Health Authorities in Italy were included. HF was defined as either: 1) hospital discharge with HF diagnosis (ICD‐9: 428) and/or 2) chronic treatment for HF identified as concomitant (within 45days) prescription of any combination of ACE inhibitors, digoxin, furosemide, bisoprolol, carvedilol, spironolactone, ARB‐blockers. Depression was identified from exposure to psychotropic drugs before HF diagnosis. Cox proportional hazards models adjusted for major confounders were used. To adjust for potential residual known confounders, a propensity score analysis was performed. Sensitivity and subgroup analysis were used to demonstrate the consistency or robustness of the results. 48,117 patients with HF were identified. Of these, 3328 (6.9%) were treated for depression. Among patients with HF, those with depression were significantly older, and more likely to be women with a previous stroke. Depression significantly worsened major outcomes including all cause mortality [HR (95%CI); 1.20 (1.08–1.33)] and the composite of stroke/TIA/AMI [1.23 (1.13–1.34)]. Patients with depression had no increased risk of rehospitalisation for HF. Propensity scores and subgroup analysis confirmed these findings. Conclusion Among elderly patients with HF, depression was independently associated with poor clinical outcomes mostly due to an increase in vascular events.