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Bobo WV, Ryu E, Petterson TM, Lackore K, Cheng Y, Liu H, Suarez L, Preisig M, Cooper LT, Roger VL, Pathak J, Chamberlain AM. Bi-directional association between depression and HF: An electronic health records-based cohort study. JOURNAL OF COMORBIDITY 2021; 10:2235042X20984059. [PMID: 33489926 PMCID: PMC7768856 DOI: 10.1177/2235042x20984059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/21/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022]
Abstract
Objective: To determine whether a bi-directional relationship exists between depression and HF within a single population of individuals receiving primary care services, using longitudinal electronic health records (EHRs). Methods: This retrospective cohort study utilized EHRs for adults who received primary care services within a large healthcare system in 2006. Validated EHR-based algorithms identified 10,649 people with depression (depression cohort) and 5,911 people with HF (HF cohort) between January 1, 2006 and December 31, 2018. Each person with depression or HF was matched 1:1 with an unaffected referent on age, sex, and outpatient service use. Each cohort (with their matched referents) was followed up electronically to identify newly diagnosed HF (in the depression cohort) and depression (in the HF cohort) that occurred after the index diagnosis of depression or HF, respectively. The risks of these outcomes were compared (vs. referents) using marginal Cox proportional hazard models adjusted for 16 comorbid chronic conditions. Results: 2,024 occurrences of newly diagnosed HF were observed in the depression cohort and 944 occurrences of newly diagnosed depression were observed in the HF cohort over approximately 4–6 years of follow-up. People with depression had significantly increased risk for developing newly diagnosed HF (HR 2.08, 95% CI 1.89–2.28) and people with HF had a significantly increased risk of newly diagnosed depression (HR 1.34, 95% CI 1.17–1.54) after adjusting for all 16 comorbid chronic conditions. Conclusion: These results provide evidence of a bi-directional relationship between depression and HF independently of age, sex, and multimorbidity from chronic illnesses.
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Affiliation(s)
- William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Tanya M Petterson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kandace Lackore
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Yijing Cheng
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Hongfang Liu
- Division of Digital Health Science, Mayo Clinic, Rochester, MN, USA
| | - Laura Suarez
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Veronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Jyotishman Pathak
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,Department of Population Health Sciences, Weill Cornell Medicine, NY, NY, USA
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Vargas EA, Patel RB, Medina-Lezama J, Chirinos DA. Depressive Symptoms Are Associated with Reduced Cardiac Function Among Hispanics: Results from the PREVENCION Study. Int J Behav Med 2020; 28:531-539. [PMID: 33170471 DOI: 10.1007/s12529-020-09941-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Depressive symptoms are common among patients with heart failure and are often associated with adverse outcomes, including re-hospitalization and mortality. However, little is known about the association between depressive symptoms and subclinical markers of heart failure and cardiac function in community-based samples and little research has focused on South American Hispanics. The current study examined the cross-sectional association between depressive symptoms and cardiac function in South American Hispanic community-based adults. METHODS Participants included 527 adults enrolled in the Peruvian Study of Cardiovascular Disease (PREVENCION). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS). Markers of cardiac function were assessed by impedance cardiography and included cardiac output, cardiac index, stroke volume, and stroke volume index. Several multiple regression analyses were used to examine the association between depressive symptoms and markers of cardiac function. RESULTS In adjusted analyses, depressive symptoms were associated with reduced cardiac output, cardiac index, stroke volume, and stroke volume index. These associations remained significant between depressive symptoms and cardiac output (β = - 0.106, p = 0.014), cardiac index (β = - 0.099, p = 0.029), and stroke volume (β = - 0.095, p = 0.022), and a trend was still observed between depressive symptoms and stroke index (β = - 0.083, p = 0.061), even after having controlled for demographic factors (age, gender, education), cardiovascular risk factors (smoking status, body mass index, low- and high-density lipoprotein cholesterol, triglycerides, fasting glucose, serum creatinine), and comorbidities (diabetes mellitus, hypertension, hypercholesterolemia). CONCLUSIONS In the PREVENCION sample tested, depressive symptoms were independently associated with cardiac function among Hispanic adults, even above and beyond pertinent factors such as demographic factors, cardiovascular risk factors, and comorbidities. Future studies should determine whether depressive symptoms are prospectively associated with systolic dysfunction, and examine the bio-behavioral pathways of this association.
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Affiliation(s)
- Emily A Vargas
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 Lake Shore Dr, Chicago, IL, 60611, USA.
| | - Ravi B Patel
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 Lake Shore Dr, Chicago, IL, 60611, USA
| | | | - Diana A Chirinos
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 Lake Shore Dr, Chicago, IL, 60611, USA
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Ludmir J, Small AJ. The Challenge of Identifying and Addressing Psychological Comorbidities. J Am Coll Cardiol 2019; 71:1590-1593. [PMID: 29622167 DOI: 10.1016/j.jacc.2018.02.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Jonathan Ludmir
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Adam J Small
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
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Liguori I, Russo G, Curcio F, Sasso G, Della-Morte D, Gargiulo G, Pirozzi F, Cacciatore F, Bonaduce D, Abete P, Testa G. Depression and chronic heart failure in the elderly: an intriguing relationship. J Geriatr Cardiol 2018; 15:451-459. [PMID: 30108618 PMCID: PMC6087518 DOI: 10.11909/j.issn.1671-5411.2018.06.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/10/2018] [Accepted: 03/13/2018] [Indexed: 12/22/2022] Open
Abstract
Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including: psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.
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Affiliation(s)
- Ilaria Liguori
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Gennaro Russo
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Francesco Curcio
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Giuseppe Sasso
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - David Della-Morte
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- IRCCS San Raffaele Pisana, Rome, Italy
| | - Gaetano Gargiulo
- Division of Internal Medicine, AOU San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
| | - Flora Pirozzi
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Francesco Cacciatore
- Azienda Ospedaliera dei Colli, Monaldi Hospital, Heart Transplantation Unit, Naples, Italy
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Gianluca Testa
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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Cognitive Function Does Not Impact Self-reported Health-Related Quality of Life in Heart Failure Patients. J Cardiovasc Nurs 2018; 31:405-11. [PMID: 26132279 DOI: 10.1097/jcn.0000000000000277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adults with heart failure (HF) often demonstrate impairment across multiple domains of cognitive functioning and report poor health-related quality of life (HRQoL). Previous researchers have found that cognitive deficits were generally not associated with HRQoL in a carefully evaluated sample. The exception was memory, which was only weakly associated with HRQoL. However, cognitive deficits interfere with self-care and disease self-management, which could be expected to affect HRQoL. OBJECTIVE We sought to verify this counterintuitive finding in a large well-characterized sample of HF patients using a well-validated neuropsychological battery. METHODS Participants were 302 adults (63% male) predominately white (72.5%) HF patients (68.7 ± 9.6 years) recruited from 2 medical centers. Self-reported HRQoL was assessed using the Kansas City Cardiomyopathy Questionnaire. Participants completed a neuropsychological battery examining attention, executive function, memory, and visuospatial functioning. Hierarchical multiple linear regression was used for analyses. RESULTS Mild global cognitive impairment was observed in 29.5% of the sample (Modified Mini-Mental State [3MS] Examination score <90). Controlling for gender, depression, HF severity, premorbid IQ, comorbidities, and education, only executive function predicted HRQoL, β = .17, P < .05. However, executive function accounted for only 0.6% of the variance in HRQoL. CONCLUSION Cognitive function generally did not predict HRQoL in HF patients. The correlates of HRQoL in HF do not appear to include mild cognitive impairment. Other factors may play a bigger role such as disease severity, age, and depressive symptoms. Future studies should investigate modifiable determinants of HRQoL in HF patients, toward the goal of finding interventions that preserve HRQoL during this chronic illness.
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Bowen GS, Diop MS, Jiang L, Wu W, Rudolph JL. A Multivariable Prediction Model for Mortality in Individuals Admitted for Heart Failure. J Am Geriatr Soc 2018; 66:902-908. [DOI: 10.1111/jgs.15319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Garrett S. Bowen
- Primary Care and Population Medicine Program, Warren Alpert Medical SchoolBrown UniversityProvidence Rhode Island
- Center of Innovation in Long‐term Services and SupportsProvidence Veterans Affairs Medical CenterProvidence Rhode Island
| | - Michelle S. Diop
- Primary Care and Population Medicine Program, Warren Alpert Medical SchoolBrown UniversityProvidence Rhode Island
- Center of Innovation in Long‐term Services and SupportsProvidence Veterans Affairs Medical CenterProvidence Rhode Island
| | - Lan Jiang
- Center of Innovation in Long‐term Services and SupportsProvidence Veterans Affairs Medical CenterProvidence Rhode Island
| | - Wen‐Chih Wu
- Center of Innovation in Long‐term Services and SupportsProvidence Veterans Affairs Medical CenterProvidence Rhode Island
- Department of Medicine, Warren Alpert Medical SchoolBrown UniversityProvidence Rhode Island
- Center for Gerontology, School of Public HealthBrown UniversityProvidence Rhode Island
| | - James L. Rudolph
- Center of Innovation in Long‐term Services and SupportsProvidence Veterans Affairs Medical CenterProvidence Rhode Island
- Department of Medicine, Warren Alpert Medical SchoolBrown UniversityProvidence Rhode Island
- Center for Gerontology, School of Public HealthBrown UniversityProvidence Rhode Island
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Jeyanantham K, Kotecha D, Thanki D, Dekker R, Lane DA. Effects of cognitive behavioural therapy for depression in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 2017; 22:731-741. [PMID: 28733911 PMCID: PMC5635071 DOI: 10.1007/s10741-017-9640-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This systematic review and meta-analysis aimed to evaluate the effects of cognitive behavioural therapy (CBT) on depression, quality of life, hospitalisations and mortality in heart failure patients. The search strategy was developed for Ovid MEDLINE and modified accordingly to search the following bibliographic databases: PubMed, EMBASE, PsycINFO, CENTRAL and CINAHL. Databases were searched from inception to 6 March 2016 for randomised controlled trials (RCTs) or observational studies that used CBT in heart failure patients with depression or depressive symptoms. Six studies were identified: 5 RCTs and 1 observational study, comprising 320 participants with predominantly NYHA classes II-III, who were mostly male, with mean age ranging from 55 to 66 years. Compared to usual care, CBT was associated with a greater improvement in depression scores both initially after CBT sessions (standardised mean difference -0.34, 95% CI -0.60 to -0.08, p = 0.01) and at 3 months follow-up (standardised mean difference -0.32, 95% CI -0.59 to -0.04, p = 0.03). Greater improvement in quality of life scores was evident for the CBT group initially after CBT sessions, but with no difference at 3 months. Hospital admissions and mortality were similar, regardless of treatment group. CBT may be more effective than usual care at improving depression scores and quality of life for heart failure patients initially following CBT and for depression at 3 months. Larger and more robust RCTs are needed to evaluate the long-term clinical effects of CBT in heart failure patients.
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Affiliation(s)
- Kishaan Jeyanantham
- The Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Dipak Kotecha
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK
- Monash University Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia
| | - Devsaagar Thanki
- The Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | - Deirdre A Lane
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK.
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Iwagami M, Tomlinson LA, Mansfield KE, McDonald HI, Smeeth L, Nitsch D. Prevalence, incidence, indication, and choice of antidepressants in patients with and without chronic kidney disease: a matched cohort study in UK Clinical Practice Research Datalink. Pharmacoepidemiol Drug Saf 2017; 26:792-801. [PMID: 28397412 PMCID: PMC5516188 DOI: 10.1002/pds.4212] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/03/2017] [Accepted: 03/19/2017] [Indexed: 12/19/2022]
Abstract
Purpose People with chronic kidney disease (CKD) have an increased prevalence of depression, anxiety, and neuropathic pain. We examined prevalence, incidence, indication for, and choice of antidepressants among patients with and without CKD. Methods Using the UK Clinical Practice Research Datalink, we identified patients with CKD (two measurements of estimated glomerular filtration rate < 60 mL/min/1.73m2 for ≥3 months) between April 2004 and March 2014. We compared those with CKD to a general population cohort without CKD (matched on age, sex, general practice, and calendar time [index date]). We identified any antidepressant prescribing in the six months prior to index date (prevalence), the first prescription after index date among non‐prevalent users (incidence), and recorded diagnoses (indication). We compared antidepressant choice between patients with and without CKD among patients with a diagnosis of depression. Results There were 242 349 matched patients (median age 76 [interquartile range 70–82], male 39.3%) with and without CKD. Prevalence of antidepressant prescribing was 16.3 and 11.9%, and incidence was 57.2 and 42.4/1000 person‐years, in patients with and without CKD, respectively. After adjusting for confounders, CKD remained associated with higher prevalence and incidence of antidepressant prescription. Regardless of CKD status, selective serotonin reuptake inhibitors were predominantly prescribed for depression or anxiety, while tricyclic antidepressants were prescribed for neuropathic pain or other reasons. Antidepressant choice was similar in depressed patients with and without CKD. Conclusions The rate of antidepressant prescribing was nearly one and a half times higher among people with CKD than in the general population. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd
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Affiliation(s)
- Masao Iwagami
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Laurie A Tomlinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen I McDonald
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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9
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Matsuda R, Kohno T, Kohsaka S, Fukuoka R, Maekawa Y, Sano M, Takatsuki S, Fukuda K. The prevalence of poor sleep quality and its association with depression and anxiety scores in patients admitted for cardiovascular disease: A cross-sectional designed study. Int J Cardiol 2017; 228:977-982. [DOI: 10.1016/j.ijcard.2016.11.091] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/06/2016] [Indexed: 01/16/2023]
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Abstract
OBJECTIVE Psychological distress has been associated with poor outcomes in patients with chronic heart failure (HF), which is assumed to be partly due to poor HF self-care behavior. This systematic review and meta-analysis describes the current evidence concerning psychological determinants of self-care in patients with chronic HF. METHODS Eligible studies were systematically identified by searching electronic databases PubMed, PsycINFO, and the Conference Proceedings Citation Index (Web of Science) for relevant literature (1980-October 17, 2014). Study quality was assessed according to the level of risk of bias. Quantitative data were pooled using random-effects models. RESULTS Sixty-five studies were identified for inclusion that varied considerably with respect to sample and study characteristics. Risk of bias was high in the reviewed studies and most problematic with regard to selection bias (67%). Depression (r = -0.19, p < .001), self-efficacy (r = 0.37, p < .001), and mental well-being (r = 0.14, p = .030) were significantly associated with self-reported self-care. Anxiety was not significantly associated with either self-reported (r = -0.18, p = .24) or objective self-care (r = -0.04, p = .79), neither was depression associated with objectively measured medication adherence (r = -0.05, p = .44). CONCLUSIONS Psychological factors (depression, self-efficacy, and mental well-being) were associated with specific self-care facets in patients with chronic HF. These associations were predominantly observed with self-reported indices of self-care and not objective indices. Methodological heterogeneity and limitations preclude definite conclusions about the association between psychological factors and self-care and should be addressed in future research.
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Gustad LT, Bjerkeset O, Strand LB, Janszky I, Salvesen Ø, Dalen H. Cardiac function associated with previous, current and repeated depression and anxiety symptoms in a healthy population: the HUNT study. Open Heart 2016; 3:e000363. [PMID: 26925243 PMCID: PMC4762188 DOI: 10.1136/openhrt-2015-000363] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Symptoms of anxiety and depression often co-exist with cardiovascular disease (CVD), yet little is known about the association with left ventricular (LV) subclinical dysfunction. We aimed to study the cross-sectional associations of previous, current and repeated depression or anxiety symptoms, with sensitive indices of LV systolic and diastolic function, based on tissue Doppler (TD) and speckle tracking (ST) imaging methods. METHODS A random selection of 1296 individuals free from known CVD, hypertension and diabetes were examined with echocardiography at baseline of the third Nord-Trøndelag Health Study, (HUNT3, 2006-2008). The primary outcomes were LV diastolic function (e') and LV systolic function (longitudinal global strain). The primary exposures were self-report on the Hospital Anxiety and Depression Scale (HADS). Associations between outcomes and baseline exposures were available for 1034 (80%), and with previous and repeated exposures for 700 participants who also participated in HUNT2 (1995-1997). RESULTS Previous and repeated depression symptoms, but not current depression, were linearly associated with a reduction in e'. The average sum of two repeated HADS-D scores 10 years apart had the strongest effect on e' (-8.3%; 95% CI -13.9% to -2.7%) per 5 units. We observed a sex difference between depression symptoms and longitudinal global strain (p for interaction 0.019), where women had a marginal negative effect. Anxiety symptoms, neither previous, current nor repeated were associated with subclinical LV dysfunction. CONCLUSIONS In a healthy sample, confirmed free of CVD, past and repeated depression symptoms were associated with subclinical LV dysfunction. Thus, depression symptoms might represent a modifiable risk factor for future CVD.
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Affiliation(s)
- L T Gustad
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway; Department of Neuroscience, Norwegian University of Technology and Science (NTNU), Trondheim, Norway
| | - O Bjerkeset
- Department of Neuroscience, Norwegian University of Technology and Science (NTNU), Trondheim, Norway; Faculty of Health Sciences, Nord University, Levanger, Norway
| | - L B Strand
- Department of Public Health and General Practice , NTNU , Trondheim , Norway
| | - I Janszky
- Department of Public Health and General Practice, NTNU, Trondheim, Norway; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Ø Salvesen
- Department of Public Health and General Practice , NTNU , Trondheim , Norway
| | - H Dalen
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway; MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Changes in Depressive Symptoms and Mortality in Patients With Heart Failure: Effects of Cognitive-Affective and Somatic Symptoms. Psychosom Med 2015; 77:798-807. [PMID: 26230482 PMCID: PMC4565732 DOI: 10.1097/psy.0000000000000221] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Depression is an independent predictor of adverse outcomes in patients with heart failure (HF). However, the effect of changes in cognitive-affective and somatic symptoms on mortality of HF patients is not known. The purpose of this study was to examine whether changes in cognitive-affective and somatic depressive symptoms over time were associated with mortality in HF. METHODS In this secondary analysis of data from the Rural Education to Improve Outcomes in Heart Failure clinical trial, we analyzed data from 457 HF patients (39% female, mean [standard deviation] age = 65.6 [12.8] years) who survived at least 1 year and repeated the Patient Health Questionnaire at 1 year. Cognitive-affective and somatic depression scores were calculated, respectively, based on published Patient Health Questionnaire factor models. Using Cox proportional hazards regression analyses, we evaluated the effect of changes in cognitive-affective and somatic symptoms from baseline to 1 year on cardiac and all-cause deaths. RESULTS Controlling for baseline depression scores and other patient characteristics, the change in somatic symptoms was associated with increased risk of cardiac death during the subsequent 1-year period (hazard ratio = 1.24, 95% confidence interval = 1.07-1.44, p = .005), but the change in cognitive-affective symptoms was not (hazard ratio = 0.94, 95% confidence interval = 0.81-1.08, p = .38). Similar results were found for all-cause mortality. CONCLUSIONS Worsening somatic depressive symptoms, not cognitive-affective symptoms, are independently associated with increased mortality of HF patients. The findings suggest that routine and ongoing assessment of somatic depressive symptoms in HF patients may help clinicians identify patients at increased risk for adverse outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT00415545.
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Okasha T, Radwan AS. The bidirectional relation between psychiatric disorders with selected cardiovascular and endocrinal diseases: an Egyptian perspective. Curr Psychiatry Rep 2015; 17:528. [PMID: 25413635 DOI: 10.1007/s11920-014-0528-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cardiovascular and endocrine diseases may act as burdens for individuals suffering from one of these medical illnesses, and whether through the ensuing psychological distress, or some biological mechanisms, these medical diseases can eventually lead to the development of psychiatric morbidities. Moreover, psychiatric morbidities negatively affect the prognosis of both cardiovascular and endocrine diseases. Despite transcultural differences, Egyptian patients with ischemic heart diseases (ISHD), heart failure (HF), diabetes mellitus (DM), or thyroid diseases (TD) endure the same psychological distress as their Western counterparts. Psychiatric assessment and evaluation should be regularly repeated among patients with cardiovascular and endocrinal diseases, and patients who are at risk should be closely followed up.
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Affiliation(s)
- Tarek Okasha
- Institute of Psychiatry, Ain Shams University, Cairo, Egypt,
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Gustad LT, Laugsand LE, Janszky I, Dalen H, Bjerkeset O. Symptoms of anxiety and depression and risk of heart failure: the HUNT Study. Eur J Heart Fail 2014; 16:861-70. [PMID: 25044493 PMCID: PMC4255780 DOI: 10.1002/ejhf.133] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/05/2014] [Accepted: 06/13/2014] [Indexed: 11/07/2022] Open
Abstract
AIMS Symptoms of anxiety and depression often co-exist with cardiovascular disease, yet little is known about the prospective risk for heart failure (HF) in people with symptoms of depression and anxiety. We aimed to study these prospective associations using self-reported symptoms of anxiety, depression, and mixed symptoms of anxiety and depression (MSAD) in a large population sample. METHODS AND RESULTS In the second wave of the Nord-Trøndelag Health Study (HUNT 2, 1995-1997), Norway, baseline data on symptoms of anxiety and depression, socio-demographic variables, health status including cardiovascular risk factors, and common chronic somatic diseases were registered for 62,567 adults, men and women, free of known HF. The cohort was followed for incident HF from baseline throughout 2008. A total of 1499 cases of HF occurred during a mean follow-up of 11.3 years (SD = 2.9), identified either in hospital registers or by the National Cause of Death Registry. There was no excess risk for future HF associated with symptoms of anxiety or MSAD at baseline. For depression, the multi-adjusted hazard ratios for HF were 1.07 (0.87-1.30) for moderate symptoms and 1.41 (1.07-1.87) for severe symptoms (P for trend 0.026). Established cardiovascular risk factors, acute myocardial infarction (AMI) prior to baseline, and adjustment for incident AMI as a time-dependent covariate during follow-up had little influence on the estimates. CONCLUSION Symptoms of depression, but not symptoms of anxiety or MSAD, were associated with increased risk for HF in a dose-response manner. The increased risk could not be fully explained by cardiovascular or socio-economic risk factors, or by co-morbid AMI.
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Affiliation(s)
- Lise T Gustad
- Department of Internal Medicine, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway; Department of Neuroscience, Norwegian University of Technology and Science (NTNU), Trondheim, Norway
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Fan H, Yu W, Zhang Q, Cao H, Li J, Wang J, Shao Y, Hu X. Depression after heart failure and risk of cardiovascular and all-cause mortality: a meta-analysis. Prev Med 2014; 63:36-42. [PMID: 24632228 DOI: 10.1016/j.ypmed.2014.03.007] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/01/2014] [Accepted: 03/03/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this study is to investigate whether depression after heart failure (HF) was a predictor for subsequent cardiovascular and all-cause mortality in prospective observational studies. METHODS Pubmed, Embase, and PsycInfo databases were searched for prospective studies reported depression after HF and subsequent risk of cardiovascular or all-cause mortality (prior to May 2013). Pooled adjust hazard ratio (HR) and corresponding 95% confidence intervals (CI) were calculated separately for categorical risk estimates. RESULTS Nine studies with 4012 HF patients were identified and analyzed. Pooled HR of all-cause mortality was 1.51 (95% CI 1.19-1.91) for depression compared with non-depressive patients. Subgroup analyses showed that major depression significantly increased all-cause mortality (HR=1.98, 95% CI 1.23-3.19), but not mild depression (HR=1.04, 95% CI 0.75-1.45). Pooled HR of cardiovascular mortality was 2.19 (95% CI 1.46-3.29) for depression compared with non-depressive patients. CONCLUSION Major depression after HF was a predictor for subsequent all-cause mortality, but not mild depression. More well-designed studies are needed to explore the influence of depression and antidepressant medication use on cardiovascular and all-cause mortality in HF patients.
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Affiliation(s)
- Hongjie Fan
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Weidong Yu
- Department of Geriatrics, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Qiang Zhang
- Department of Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Hui Cao
- Department of Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Jun Li
- Department of Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Junpeng Wang
- Department of Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Yang Shao
- Department of Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Xinhua Hu
- Department of Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China.
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Xu SD, Su GH, Lu YX, Shuai XX, Tao XF, Meng YD, Luo P. Elevated Soluble ST2 and Depression Increased the Risk of All-Cause Mortality and Hospitalization in Patients With Heart Failure. Int Heart J 2014; 55:445-50. [DOI: 10.1536/ihj.13-371] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Su-Dan Xu
- Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology
| | - Guan-Hua Su
- Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology
| | - Yong-Xin Lu
- Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology
| | - Xin-Xin Shuai
- Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology
| | - Xiao-Fang Tao
- Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology
| | - Yi-Di Meng
- Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology
| | - Ping Luo
- Department of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology
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Abstract
OBJECTIVES Clinical outcomes are worse for patients with heart failure (HF) and elevated depression symptoms. Depression-related sympathoimmune dysregulation may be one mechanism leading to poorer HF prognosis. Sympathetically mediated adrenergic activity is known to regulate immune activity via β-adrenergic receptors (β-ARs). However, studies show conflicting relationships between leukocyte β-AR sensitivity and depression symptoms. The aim of this study was to determine in patients with HF the relationship of leukocyte β-AR sensitivity with two diverse measures of depression, self-report questionnaire versus clinical diagnostic interview. METHODS Patients with HF (N = 73, mean [standard deviation] age = 56.3 [13.0]) completed the Beck Depression Inventory-1A and a modified Structured Clinical Interview for the DSM-IV. Leukocyte β-AR sensitivity was determined from isoproterenol-stimulated cyclic adenosine monophosphate levels; plasma norepinephrine and epinephrine were also assessed. RESULTS Patients with major depression determined by Structured Clinical Interview for the DSM-IV had significantly higher β-AR sensitivity than did nondepressed patients (F(6,72) = 9.27, p = .003, η = 0.12). The Beck Depression Inventory-1A revealed a more complex relationship. Minimal, mild, and moderate-to-severe depression symptom groups had significant differences in β-AR sensitivity (F(7,72) = 7.03, p = .002, η = 0.18); mild symptoms were associated with reduced β-AR sensitivity and moderate-to-severe symptoms with higher β-AR sensitivity compared with patients with minimal depressive symptoms. CONCLUSIONS Clinical depression was associated with elevated β-AR sensitivity in patients with HF. By deconstructing depression measurements, a greater depth of information may be garnered to potentially reveal subtypes of depression symptoms and their relation to β-AR sensitivity.
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Erceg P, Despotovic N, Milosevic DP, Soldatovic I, Zdravkovic S, Tomic S, Markovic I, Mihajlovic G, Brajovic MD, Bojovic O, Potic B, Davidovic M. Health-related quality of life in elderly patients hospitalized with chronic heart failure. Clin Interv Aging 2013; 8:1539-46. [PMID: 24255598 PMCID: PMC3832382 DOI: 10.2147/cia.s53305] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Chronic heart failure is a very common condition in the elderly, characterized not only by high mortality rates, but also by a strong impact on health-related quality of life (HRQOL). Previous studies of HRQOL in elderly heart failure subjects have included mostly outpatients, and little is known about determinants of HRQOL in hospitalized elderly population, especially in Serbia. In this study, we tried to identify factors that influence HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Methods The study population consisted of 136 patients aged 65 years or older hospitalized for chronic heart failure. HRQOL was assessed using the Minnesota Living with Heart Failure questionnaire. Predictors of HRQOL were identified by multiple linear regression analysis. Results Univariate analysis showed that patients with lower income, a longer history of chronic heart failure, and longer length of hospital stay, as well as those receiving aldosterone antagonists and digoxin, taking multiple medications, in a higher NYHA class, and showing signs of depression and cognitive impairment had significantly worse HRQOL. Presence of depressive symptoms (P<0.001), higher NYHA class (P=0.021), lower income (P=0.029), and longer duration of heart failure (P=0.049) were independent predictors of poor HRQOL. Conclusion Depressive symptoms, higher NYHA class, lower income, and longer duration of chronic heart failure are independent predictors of poor HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Further, there is an association between multiple medication usage and poor HRQOL, as well as a negative impact of cognitive impairment on HRQOL. Hence, measures should be implemented to identify such patients, especially those with depressive symptoms, and appropriate interventions undertaken in order to improve their HRQOL.
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Affiliation(s)
- Predrag Erceg
- Department of Gerontology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia ; Clinical Department of Geriatrics, Zvezdara University Hospital, Belgrade, Serbia
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Jiang P, Zhang WY, Li HD, Cai HL, Liu YP, Chen LY. Stress and vitamin D: altered vitamin D metabolism in both the hippocampus and myocardium of chronic unpredictable mild stress exposed rats. Psychoneuroendocrinology 2013; 38:2091-8. [PMID: 23608137 DOI: 10.1016/j.psyneuen.2013.03.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 03/18/2013] [Accepted: 03/25/2013] [Indexed: 12/27/2022]
Abstract
Exposure to stressful life events is associated with the onset of major depression and increases the risk of cardiac morbidity and mortality. While recent evidence has indicated the existence of an interrelationship between local vitamin D (VD) metabolism and many aspects of human physiology including brain and heart function, much is still unknown concerning the biological link between VD signaling and stress-induced depressive behavior and cardiac dysfunction. In the present study, we observed the VD intracrine system in the hippocampus and myocardium of chronic unpredictable mild stress (CUMS) exposed rats. After 4 weeks of CUMS procedure, rats were induced to a depressive-like state and the cytochromes P450 enzymes involved in VD activating and catabolizing (CYP27B1 and CYP24A1 respectively) and VD receptor (VDR) were assessed by real time RT-PCR and western blot in the hippocampus, myocardium and kidney. In the hippocampus of depressed rats, CYP27B1, CYP24A1 and VDR expression were significantly increased and the local status of 1,25-dihydroxyvitamin D (1,25(OH)2D) was higher compared with controls. Furthermore, hippocampal mRNA levels of VD target genes (calbindin-d28k, neurotrophin-3) and RXRα (heterodimeric partner of VDR) were upregulated in response to chronic stress. Similar to the hippocampus, CUMS also induced CYP27B1/CYP24A1/VDR expression in the myocardium. However, renal metabolism of VD and serum1,25(OH)2D status were unchanged. Meanwhile, sertraline treatment could partly normalize the stress-induced alterations of VD metabolism. In conclusion, this study firstly showed a co-elevated expression of CYP27B1/CYP24A1/VDR in both the hippocampus and myocardium of CUMS rats, which suggests VD signaling may be involved in the compensatory mechanism that protect from stress-induced deteriorating effects on the brain and heart.
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Affiliation(s)
- Pei Jiang
- Institute of Clinical Pharmacy & Pharmacology, Second Xiangya Hospital, Central South University, Changsha, China; School of Pharmaceutical Sciences, Central South University, Changsha, China
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O’Neil A, Berk M, Davis J, Stafford L. Cardiac-self efficacy predicts adverse outcomes in coronary artery disease (CAD) patients. Health (London) 2013. [DOI: 10.4236/health.2013.57a3002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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