Depressive symptoms increase risk of rehospitalisation in heart failure patients with preserved systolic function

Association of Psychosocial Risk Factors and Outcomes in Heart Failure: Does COVID-19 Affect Outcomes?

Psychosocial risk factors (PSRFs) have emerged as crucial nontraditional risk factors affecting outcomes in patients with heart failure (HF). There is a paucity of data studying these risk factors in HF nationally. Additionally, whether the COVID-19 pandemic impacted outcomes remains unexplored, given the increased psychosocial risk during these times. Our objective is to assess the impact of PSRFs on the outcomes of HF and their comparison across non-COVID-19 and COVID-19 eras. Patients with a diagnosis of HF were selected using the 2019-2020 Nationwide Readmissions Database. Two cohorts were created based on the presence or absence of PSRFs and compared across non-COVID-19 and COVID-19 eras. We examined the association using hierarchical multivariable logistic regression models. A total of 305,955 patients were included, of which 175,348 (57%) had PSRFs. Patients with PSRFs were younger, less likely to be female, and had a higher prevalence of cardiovascular risk factors. All-cause readmissions were higher in patients with PSRFs in both the eras. All-cause mortality [odds ratio, OR 1.15 (1.04-1.27), P = 0.005] and composite of MACE [OR 1.11 (1.06-1.16), P < 0.001] were higher in patients in the non-COVID-19 era. Compared to 2019, patients with PSRFs and HF in 2020 had significantly higher all-cause mortality [OR 1.13 (1.03-1.24), P = 0.009]; however, the composite of MACE was comparable [OR 1.04 (1.00-1.09), P = 0.03]. In conclusion, the presence of PSRFs in patients with HF is associated with a significant increase in all-cause readmissions in COVID-19 and non-COVID-19 eras. The worse outcomes evident in the COVID-19 era highlights the importance of multidisciplinary care in this vulnerable population.

Depressive Symptoms Are Associated with Reduced Cardiac Function Among Hispanics: Results from the PREVENCION Study

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.

Trajectories of cognitive-affective depressive symptoms in acutely hospitalized older adults: The hospital-ADL study

OBJECTIVE

To identify trajectories of cognitive-affective depressive symptoms among acutely hospitalized older patients and whether trajectories are related to prognostic baseline factors and three-month outcomes such as functional decline, falls, unplanned readmissions, and mortality.

METHODS

Prospective multicenter cohort of acutely hospitalized patients aged ≥ 70. Depressive trajectories were based on Group Based Trajectory Modeling, using the Geriatric Depression Scale-15. Outcomes were functional decline, falls, unplanned readmission, and mortality within three months post-discharge.

RESULTS

The analytic sample included 398 patients (mean age = 79.6 years; SD = 6.6). Three distinct depressive symptoms trajectories were identified: minimal (63.6%), mild persistent (25.4%), and severe persistent (11.0%). Unadjusted results showed that, compared to the minimal symptoms group, the mild and severe persistent groups showed a significantly higher risk of functional decline (mild: OR = 3.9, p < .001; severe: OR = 3.0, p = .04), falls (mild: OR = 2.0, p = .02; severe: OR = 6.0, p < .001), and mortality (mild: OR = 2.2, p = .05; severe: OR = 3.4, p = .009). Patients with mild or severe persistent symptoms were more malnourished, anxious, and functionally limited and had more medical comorbidities at admission.

CONCLUSION

Nearly 40% of the acutely hospitalized older adults exhibited mild to severe levels of cognitive-affective depressive symptoms. In light of the substantially elevated risk of serious complications and the fact that elevated depressive symptoms was not a transient phenomenon identification of these patients is needed. This further emphasizes the need for acute care hospitals, as a point of engagement with older adults, to develop discharge or screening procedures for managing cognitive-affective depressive symptoms.

Determinates of depressive disorder among adult patients with cardiovascular disease at outpatient cardiac clinic Jimma University Teaching Hospital, South West Ethiopia: cross-sectional study

BACKGROUND

Depression and heart disease are an important public-health problem. Depression is one of the most prevalent and disabling psychiatric disorders with more than three times increased risk among patients with cardiovascular disorders.

OBJECTIVE

To identify the prevalence and associated factors of depressive disorder among adult patients with cardiovascular disease.

METHODS

Institution based cross-sectional study design was used to conduct this study on 293 study participants attending an outpatient cardiac clinic at Jimma University Teaching Hospital. All eligible patients were recruited into the study consecutively. Depression was assessed using patient health questionnaire-9. The patient health questionnaire-9 had a total score of 27, from which 0-4: no/minimal depression, 5-9: mild depression, 10-14: moderately depression, 15-19: moderately severe depression and 20-27 severe depression. The data was feed into Epi-data version 3.1 and lastly exported to SPSS version 21 for analysis. Bivariate analysis was used to analyze the statistical association of covariates of interest with depressive disorder among patients with cardiovascular disease. Then, logistic regression analysis was used as a final model to control confounders. The strength of association was measured by a 95% confidence interval.

RESULTS

A total of 293 adult patients diagnosed with the cardiovascular disease were included in the study with 97% (n = 284) of response rate, 47.2% (n = 134) males and 52.8% (n = 150) females, making female to a male ratio around 1.1:1. The prevalence of depression was 52.8% (n = 150/284). Out of the subjects with depression 52.67% (n = 79), 36.0% (n = 54) and 11.33% (n = 17) were mild, moderate and severe depression, respectively. Variables such as employed, unemployed, physical activity, current cigarette user and poor social support were independently associated with depression in the final model.

CONCLUSIONS

In this study, depression was found to be highly prevalent psychiatric comorbidity in adult cardiovascular disease patients.

Micronutrient Deficiency Independently Predicts Time to Event in Patients With Heart Failure

Background Dietary micronutrient deficiencies have been shown to predict event-free survival in other countries but have not been examined in patients with heart failure living in the United States. The purpose of this study was to determine whether number of dietary micronutrient deficiencies in patients with heart failure was associated with shorter event-free survival, defined as a combined end point of all-cause hospitalization and death. Methods and Results Four-day food diaries were collected from 246 patients with heart failure (age: 61.5±12 years; 67% male; 73% white; 45% New York Heart Association [NYHA] class III / IV ) and analyzed using Nutrition Data Systems for Research. Micronutrient deficiencies were determined according to methods recommended by the Institute of Medicine. Patients were followed for 1 year to collect data on all-cause hospitalization or death. Patients were divided according to number of dietary micronutrient deficiencies at a cut point of ≥7 for the high deficiency category versus <7 for the no to moderate deficiency category. In the full sample, 29.8% of patients experienced hospitalization or death during the year, including 44.3% in the high-deficiency group and 25.1% in the no/moderate group. The difference in survival distribution was significant (log rank, P=0.0065). In a Cox regression, micronutrient deficiency category predicted time to event with depression, NYHA classification, comorbidity burden, body mass index, calorie and sodium intake, and prescribed angiotensin-converting enzyme inhibitors, diuretics, or β-blockers included as covariates. Conclusions This study provides additional convincing evidence that diet quality of patients with heart failure plays an important role in heart failure outcomes.

Depression Effects on Hospital Cost of Heart Failure Patients in California: An Analysis by Ethnicity and Gender

Background

Depression often interferes with self-management and treatment of medical conditions. This may result in serious medical complications and escalated health-care cost.

Objectives

Study distribution of heart failure (HF) cases estimates the prevalence of depression and its effects on HF-related hospital costs by ethnicity and gender.

Methods

Secondary data files of California Hospital Discharge System for he year 2010 were examined. For patients with a HF diagnosis, details regarding depression, demographics, comorbid conditions, and hospital costs were studied. Age-adjusted HF rates and depression were examined for whites, blacks, Hispanics, and Asians/Pacific Islanders (AP) by comparing HF patients with depression (HF^+D) versus HF without depression (HF^ND).

Results

HF cases (n = 62,685; average age: 73) included nearly an equal number of males and females. HF rates were higher (P < 0.001) among blacks compared to Hispanics, AP, and whites and higher among males than females. One-fifth of HF patients had depression, higher among females and whites compared to males and other ethnic groups. Further, HF hospital costs for blacks and AP were higher (P < 0.001) compared to other groups. The cost for HF^+D was 22% higher compared to HF^ND, across all gender and ethnic groups, largely due to higher comorbidities, more admissions, and longer hospitalization.

Conclusion

Depression, ethnicity, and gender are all associated with increased hospital costs of HF patients. The higher HF and HF^+D costs among blacks, AP, and males reflect additional burden of comorbidities (hypertension and diabetes). Prospective studies to assess if selective screening and treating depression among HF patients can reduce hospital costs are warranted.

Factors Affecting Health Related Quality of Life in Hospitalized Patients with Heart Failure

This study identified factors affecting health related quality of life (HRQOL) in 300 hospitalized patients with heart failure (HF). Data were collected by the completion of a questionnaire which included patients' characteristics and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Analysis of data showed that the median of the total score of MLHFQ was 46 and the median of the physical and mental state was 22 and 6, respectively. Also, participants who were householders or had “other” professions had lower score of 17 points and therefore better quality of life compared to patients who were civil/private employees (p < 0.001 and p < 0.001, resp.). Patients not receiving anxiolytics and antidepressants had lower quality of life scores of 6 and 15.5 points, respectively, compared to patients who received (p = 0.003 and p < 0.001, resp.). Patients with no prior hospitalization had lower score of 7 points compared to those with prior hospitalization (p = 0.002), whereas patients not retired due to the disease had higher score of 7 points (p = 0.034). Similar results were observed for the physical and mental state. Improvement of HF patients' quality of life should come to the forefront of clinical practice.

Depressive Symptoms: Mediator of Event-Free Survival in Patients With Heart Failure

Depressive symptoms and poor health perceptions are predictors of higher hospitalization and mortality rates (heart failure [HF]). However, the association between depressive symptoms and health perceptions as they affect event-free survival outcomes in patients with HF has not been studied. The purpose of this secondary analysis was to determine whether depressive symptoms mediate the relationship between health perceptions and event-free survival in patients with HF. A total of 458 HF patients (61.6 ± 12 years, 55% New York Heart Association Class III/IV) responded to one-item health perception question and completed the Patient Health Questionnaire-9. Event-free survival data were collected for up to 4 years. Multiple regression and Cox proportional hazards regression analysis showed that depressive symptoms mediated the relationship between health perceptions and event-free survival. Decreasing depressive symptoms is essential to improve event-free survival in patients with HF.

Assessing Risk and Preventing 30-Day Readmissions in Decompensated Heart Failure: Opportunity to Intervene?

Heart failure (HF) patients are at high risk of hospital readmission, which contributes to substantial health care costs. There is great interest in strategies to reduce rehospitalization for HF. However, many readmissions occur within 30 days of initial hospital discharge, presenting a challenge for interventions to be instituted in a short time frame. Potential strategies to reduce readmissions for HF can be classified into three different forms. First, patients who are at high risk of readmission can be identified even before their initial index hospital discharge. Second, ambulatory remote monitoring strategies may be instituted to identify early warning signs before acute decompensation of HF occurs. Finally, strategies may be employed in the emergency department to identify low-risk patients who may not need hospital readmission. If symptoms improve with initial therapy, low-risk patients could be referred to specialized, rapid outpatient follow-up care where investigations and therapy can occur in an outpatient setting.

Depressive symptoms are associated with higher rates of readmission or mortality after medical hospitalization: A systematic review and meta-analysis

Depressive symptoms during a medical hospitalization may be an overlooked prognostic factor for adverse events postdischarge. Our aim was to evaluate whether depressive symptoms predict 30-day readmission or death after medical hospitalization. We conducted a systematic review of studies that compared postdischarge outcomes by in-hospital depressive status. We assessed study quality and pooled published and unpublished data using random effects models. Overall, one-third of 6104 patients discharged from medical wards were depressed (interquartile range, 27%-40%). Compared to inpatients without depression, those discharged with depressive symptoms were more likely to be readmitted (20.4% vs 13.7%, risk ratio [RR]: 1.73, 95% confidence interval [CI]: 1.16-2.58) or die (2.8% vs 1.5%, RR: 2.13, 95% CI: 1.31-3.44) within 30 days. Depressive symptoms were common in medical inpatients and are associated with an increased risk of adverse events postdischarge. Journal of Hospital Medicine 2016;11:373-380. © 2016 The Authors Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital Medicine.

Current depressive symptoms but not history of depression predict hospital readmission or death after discharge from medical wards: a multisite prospective cohort study

OBJECTIVE

Although death or readmission shortly after hospital discharge is frequent, identifying inpatients at higher risk is difficult. We evaluated whether in-hospital depressive symptoms (hereafter "depression") are associated with short-term readmission or mortality after discharge from medical wards.

METHODS

Depression was assessed at discharge in a prospective inpatient cohort from 2 Canadian hospitals (7 medical wards) and defined as scores ≥ 11 on the 27-point Patient Health Questionnaire (PHQ-9). Primary outcome was all-cause readmission or mortality 90 days postdischarge.

RESULTS

Of 495 medical patients [median age 64 years, 51% women, top 3 admitting diagnoses heart failure (10%), pneumonia (10%) and chronic obstructive pulmonary disease (8%)], 127 (26%) screened positive for depression at discharge. Compared with nondepressed patients, those with depression were more frequently readmitted or died: 27/127 (21%) vs. 58/368 (16%) within 30 days and 46 (36%) vs. 91 (25%) within 90 days [adjusted odds ratio (aOR) 2.00, 95% confidence interval 1.25-3.17, P=.004, adjusted for age, sex and readmission/death prediction scores]. History of depression did not predict 90-day events (aOR 1.05, 95% CI 0.64-1.72, P=.84). Depression persisted in 40% of patients at 30 days and 17% at 90 days.

CONCLUSIONS

Depression was common, underrecognized and often persisted postdischarge. Current symptoms of depression, but not history, identified greater risk of short-term events independent of current risk prediction rules.

Patient Characteristics Predicting Readmission Among Individuals Hospitalized for Heart Failure

Heart failure is difficult to manage and increasingly common with many individuals experiencing frequent hospitalizations. Little is known about patient factors consistently associated with hospital readmission. A literature review was conducted to identify heart failure patient characteristics, measured before discharge, that contribute to variation in hospital readmission rates. Database searches yielded 950 potential articles, of which 34 studies met inclusion criteria. Patient characteristics generally have a very modest effect on all-cause or heart failure-related readmission within 7 to 180 days of index hospital discharge. A range of cardiac diseases and other comorbidities only minimally increase readmission rates. No single patient characteristic stands out as a key contributor across multiple studies underscoring the challenge of developing successful interventions to reduce readmissions. Interventions may need to be general in design with the specific intervention depending on each patient's unique clinical profile.

Depression and alcohol withdrawal syndrome: is antidepressant therapy associated with lower rates of hospital readmission?

BACKGROUND

Alcohol withdrawal syndrome (AWS) is a frequent cause of admission to acute care hospitals and many of these patients have a history of depression.

AIM

Our objective was to determine if antidepressant use in patients with a history of depression is associated with lower rates of hospital readmission for AWS.

METHODS

A retrospective study was performed of patients admitted with AWS between January 1, 2006 and December 31, 2008 to an academic tertiary referral hospital.

RESULTS

Three hundred and twenty-two patients were admitted with AWS during the study period. One hundred and sixty-one patients (50 %) had no history of depression, 111 patients (34 %) had a history of depression and antidepressant use, and 50 patients (16 %) had a history of depression and no antidepressant use. There was no significant difference in the number of hospitalizations for AWS between these three groups. Patients with a history of depression on antidepressant medication were more likely to be retired or work disabled compared to the other two groups (p < 0.05). The antidepressant class most commonly used was SSRI (63 %).

CONCLUSION

Our study highlights the high frequency of depression and antidepressant use in patients admitted with AWS to an acute care hospital. As alcohol withdrawal is associated with increased morbidity and mortality and depression is common in those with alcohol use disorder, further research is necessary to clarify the optimal treatment of comorbid depression and alcohol use disorder in reducing these revolving door admissions.

Diagnosis-specific readmission risk prediction using electronic health data: a retrospective cohort study

BACKGROUND

Readmissions after hospital discharge are a common occurrence and are costly for both hospitals and patients. Previous attempts to create universal risk prediction models for readmission have not met with success. In this study we leveraged a comprehensive electronic health record to create readmission-risk models that were institution- and patient- specific in an attempt to improve our ability to predict readmission.

METHODS

This is a retrospective cohort study performed at a large midwestern tertiary care medical center. All patients with a primary discharge diagnosis of congestive heart failure, acute myocardial infarction or pneumonia over a two-year time period were included in the analysis.The main outcome was 30-day readmission. Demographic, comorbidity, laboratory, and medication data were collected on all patients from a comprehensive information warehouse. Using multivariable analysis with stepwise removal we created three risk disease-specific risk prediction models and a combined model. These models were then validated on separate cohorts.

RESULTS

3572 patients were included in the derivation cohort. Overall there was a 16.2% readmission rate. The acute myocardial infarction and pneumonia readmission-risk models performed well on a random sample validation cohort (AUC range 0.73 to 0.76) but less well on a historical validation cohort (AUC 0.66 for both). The congestive heart failure model performed poorly on both validation cohorts (AUC 0.63 and 0.64).

CONCLUSIONS

The readmission-risk models for acute myocardial infarction and pneumonia validated well on a contemporary cohort, but not as well on a historical cohort, suggesting that models such as these need to be continuously trained and adjusted to respond to local trends. The poor performance of the congestive heart failure model may suggest that for chronic disease conditions social and behavioral variables are of greater importance and improved documentation of these variables within the electronic health record should be encouraged.

Depressive symptoms and hospital readmission in older adults

OBJECTIVES

To quantify the risk of 30-day unplanned hospital readmission in adults aged 65 and older with depressive symptoms.

DESIGN

Prospective cohort study.

SETTING

University of Maryland Medical Center.

PARTICIPANTS

Individuals aged 65 and older admitted between July 1, 2011, and August 9, 2012, to the general medical and surgical units and followed for 31 days after hospital discharge (N = 750).

MEASUREMENTS

Primary exposure was depressive symptoms at admission, defined as a score of 6 or more on the 15-item Geriatric Depression Scale. Primary outcome was unplanned 30-day hospital readmission, defined as an unscheduled overnight stay at any inpatient facility not occurring in the emergency department.

RESULTS

Prevalence of depressive symptoms was 19% and incidence of 30-day unplanned hospital readmission was 19%. Depressive symptoms were not significantly associated with hospital readmission (relative risk (RR) = 1.20, 95% confidence interval (CI) = 0.83-1.72). Age, Charlson Comorbidity Index score, and number of hospitalizations within the past 6 months were significant predictors of unplanned 30-day hospital readmission.

CONCLUSION

Although not associated with hospital readmission, depressive symptoms were associated with other poor outcomes and may be underdiagnosed in hospitalized older adults. Hospitals interested in reducing readmission should focus on older adults with more comorbid illness and recent hospitalizations.

Association of Psychosocial Factors and Heart Rate Variability in Heart Failure Patients

The purpose of this study was to examine the association of psychosocial factors (depression, social support, and health-related quality of life) with heart rate variability (HRV) in patients with heart failure. The sample comprised 91 outpatients from a medical center. Data were collected using the Beck Depression Inventory-II, Medical Outcomes Study (MOS) Social Support Survey, and Minnesota Living With Heart Failure Questionnaire. HRV was measured in terms of time-domain parameters from a 24-hr ambulatory Holter electrocardiogram. After adjusting for demographic and clinical variables, quality of life and social support were significantly associated with HRV. HRV (time-domain measures) was significantly higher in patients who perceived better quality of life and more social support. Our findings suggest that nurses could screen early for patients' risk of adverse psychosocial conditions and suggest online or other social supportive interventions to help at-risk patients minimize the negative associations with HRV.

Risk factors for adverse outcomes by left ventricular ejection fraction in a contemporary heart failure population

BACKGROUND

Although heart failure (HF) is a syndrome with important differences in response to therapy by left ventricular ejection fraction (LVEF), existing risk stratification models typically group all HF patients together. The relative importance of common predictor variables for important clinical outcomes across strata of LVEF is relatively unknown.

METHODS AND RESULTS

We identified all members with HF between 2005 and 2008 from 4 integrated healthcare systems in the Cardiovascular Research Network. LVEF was categorized as preserved (LVEF ≥ 50% or normal), borderline (41%-49% or mildly reduced), and reduced (≤ 40% or moderately to severely reduced). We used Cox regression models to identify independent predictors of death and hospitalization by LVEF category. Among 30094 ambulatory adults with HF, mean age was 74 years and 46% were women. LVEF was preserved in 49.5%, borderline in 16.2%, and reduced in 34.3% of patients. During a median follow-up of 1.8 years (interquartile range, 0.8-3.1), 8060 (26.8%) patients died, 8108 (26.9%) were hospitalized for HF, and 20272 (67.4%) were hospitalized for any reason. In multivariable models, nearly all tested covariates performed similarly across LVEF strata for the outcome of death from any cause, as well as for HF-related and all-cause hospitalizations.

CONCLUSIONS

We found that in a large, diverse contemporary HF population, risk assessment was strikingly similar across all LVEF categories. These data suggest that, although many HF therapies are uniquely applied to patients with reduced LVEF, individual prognostic factor performance does not seem to be significantly related to level of left ventricular systolic function.

Depression, healthcare utilization, and death in heart failure: a community study

BACKGROUND

The increasing prevalence of heart failure (HF) and high associated costs have spurred investigation of factors leading to adverse outcomes in patients with HF. Studies to date report inconsistent evidence on the link between depression and outcomes with only limited data on emergency department and outpatient visits.

METHODS AND RESULTS

Olmsted, Dodge, and Fillmore county, Minnesota residents with HF were prospectively recruited between October 2007 and December 2010 and completed a 1-time 9-item Patient Health Questionnaire for depression categorized as: none to minimal (Patient Health Questionnaire score, 0-4), mild (5-9), or moderate to severe (≥10). Andersen-Gill models were used to determine whether depression predicted hospitalizations and emergency department visits, whereas negative binomial regression models explored the association of depression with outpatient visits. Cox proportional hazards regression characterized the relationship between depression and all-cause mortality. Among 402 patients with HF (mean age, 73±13 years; 58% men), 15% had moderate to severe depression, 26% mild, and 59% none to minimal depression. During a mean follow-up of 1.6 years, 781 hospitalizations, 1000 emergency department visits, 15 515 outpatient visits, and 74 deaths occurred. After adjustment, moderate to severe depression was associated with nearly a 2-fold increased risk of hospitalization (hazard ratio, 1.79; 95% confidence interval, 1.30-2.47) and emergency department visits (hazard ratio, 1.83; 95% confidence interval, 1.34-2.50), a modest increase in outpatient visits (rate ratio, 1.20; 95% confidence interval, 1.00-1.45), and a 4-fold increase in all-cause mortality (hazard ratio, 4.06; 95% confidence interval, 2.35-7.01).

CONCLUSIONS

In this prospective cohort study, depression independently predicted an increase in the use of healthcare resources and mortality. Greater recognition and management of depression in HF may optimize clinical outcomes and resource utilization.

Association between depression and hospital outcomes among older men

BACKGROUND

Studies that have investigated the relation between depression and the type, nature, extent and outcome of general hospital admissions have been limited by their retrospective designs and focus on specific clinical populations. We explored this relation prospectively in a large, community-based sample of older men.

METHODS

A cohort of 5411 men aged 69 years and older enrolled in the Health in Men Study was assessed at baseline for depressive symptoms, defined as a score of 7 or higher on the 15-item Geriatric Depression Scale. Participants were followed for 2 years for occurrence and number of hospital admissions, type of hospital admission, length of hospital stay and inpatient death as recorded in the Western Australian Data Linkage System.

RESULTS

Of 339 men with depressive symptoms, 152 (44.8%) had at least 1 emergency hospital admission, compared with 1164 of 5072 (22.9%) nondepressed men (p < 0.001). In multivariate analyses, the presence of depressive symptoms was a significant independent predictor of hospital admission (hazard ratio 1.67, 95% confidence interval [CI] 1.38-2.01), number of hospital admissions (incidence rate ratio [IRR] 1.22, 95% CI 1.07-1.39) and total length of hospital stay (IRR 1.65, 95% CI 1.36-2.01).

INTERPRETATION

Participants with depressive symptoms were at higher risk of hospital admission for nonpsychiatric conditions and were more likely to have longer hospital stays and worse hospital outcomes, compared with nondepressed participants. These results highlight the potential to target this high-risk group to reduce the burden of health care costs in an aging population.

Further psychometric testing of an instrument to measure emotional care in hospital

AIMS AND OBJECTIVES

This paper describes further testing of the instrument Patient Evaluation of Emotional Care during Hospitalisation.

BACKGROUND

In 2005, a questionnaire was developed that could be completed by patients to evaluate the quality of emotional care received during their time in hospital. This questionnaire was tested at an acute care private hospital in Perth, Western Australia, with encouraging estimates of reliability and validity. The purpose of this study was to further test this questionnaire in a larger sample of inpatients at a public hospital in the same state.

DESIGN

Psychometric evaluation.

METHOD

A hospital-wide survey of 13 wards of a public hospital was conducted. Two hundred and fifty-one patients completed the questionnaire.

RESULTS

Psychometric testing of the Patient Evaluation of Emotional Care during Hospitalisation demonstrated acceptable internal consistency reliability. Confirmatory factor analysis substantiated the four sub-scales as follows: Level of Security, Level of Knowing, Level of Personal Value and Level of Connection. The Level of Connection sub-scale was assessed for the first time in this study. This sub-scale had the lowest mean score of all the sub-scales across the hospital as well as in each of the wards surveyed. Qualitative data substantiated, from the patients’ perspective, a lack of connection with hospital staff.

CONCLUSIONS

Further psychometric testing of the Patient Evaluation of Emotional Care during Hospitalisation instrument has confirmed its psychometric properties and usefulness as an instrument to measure emotional care during hospitalisation.

RELEVANCE TO CLINICAL PRACTICE

The Patient Evaluation of Emotional Care during Hospitalisation is a reliable and valid tool with which the emotional care of patients in hospital can be measured and the effectiveness of interventions assessed.

Relationship between the course of depression symptoms and the left ventricular mass index and left ventricular filling pressure in chronic haemodialysis patients

AIM

Multiple measurements of depression symptoms over time were more predictive of cardiovascular mortality than a single time measurement performed at baseline. The aim of this study is to evaluate the association of the course of depression symptoms, based on repeated assessments of depression symptoms over time, with left ventricular mass index (LVMI) and left ventricular filling pressure (LVFP) in patients on haemodialysis (HD).

METHODS

The level of depression symptoms in 61 patients on HD were prospectively assessed using the Beck Depression Inventory (BDI) at baseline and at three intervals (5, 10, 15 months). Doppler echocardiographic examinations were performed at the end of follow up.

RESULTS

At the end of follow up, the patients were divided into three groups according to their course of depression symptoms: non-depression (n = 21), intermittent depression (n = 23) and persistent depression (n = 17). LVMI and LVFP were significantly increased in the persistent depression symptoms group compared to those of the non-depression symptoms group and the intermittent depression symptoms group. Persistent depression symptoms were independently associated with LVMI (β-coefficient = 0.347, P = 0.017) and LVFP (β-coefficient = 0.274, P = 0.048) after adjustment for age, sex, systolic blood pressure, diastolic blood pressure, diabetes and interdialytic weight gain.

CONCLUSION

In our study, persistent depression symptoms were associated with left ventricular hypertrophy and diastolic dysfunction. Our data may provide a more complete understanding of cardiovascular risk associated with depression symptoms in patients on HD.

Multiple aberrations in shared inflammatory and oxidative & nitrosative stress (IO&NS) pathways explain the co-association of depression and cardiovascular disorder (CVD), and the increased risk for CVD and due mortality in depressed patients

There is evidence that there is a bidirectional relationship between major depression and cardiovascular disorder (CVD): depressed patients are a population at risk for increased cardiac morbidity and mortality, and depression is more frequent in patients who suffer from CVD. There is also evidence that inflammatory and oxidative and nitrosative stress (IO&NS) pathways underpin the common pathophysiology of both CVD and major depression. Activation of these pathways may increase risk for both disorders and contribute to shared risk. The shared IO&NS pathways that may contribute to CVD and depression comprise the following: increased levels of pro-inflammatory cytokines, like interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-12, tumor necrosis factor-α, and interferon-γ; T cell activation; increased acute phase proteins, like C-reactive protein, haptoglobin, fibrinogen and α1-antitrypsin; complement factors; increased LPS load through bacterial translocation and subsequent gut-derived inflammation; induction of indoleamine 2,3-dioxygenase with increased levels of tryptophan catabolites; decreased levels of antioxidants, like coenzyme Q10, zinc, vitamin E, glutathione and glutathione peroxidase; increased O&NS characterized by oxidative damage to low density lipoprotein (LDL) and phospholipid inositol, increased malondialdehyde, and damage to DNA and mitochondria; increased nitrosative stress; and decreased ω3 polyunsaturated fatty acids (PUFAs). The complex interplay between the abovementioned IO&NS pathways in depression results in pro-atherogenic effects and should be regarded as a risk factor to future clinical CVD and due mortality. We suggest that major depression should be added as a risk factor to the Charlson "comorbidity" index. It is advised that patients with (sub)chronic or recurrent major depression should routinely be assessed by serology tests to predict if they have an increased risk to cardiovascular disorders.

Predictors of readmission and health related quality of life in patients with chronic heart failure: a comparison of different psychosocial aspects

Psychological distress is common in patients with chronic heart failure. The impact of different psychological variables on prognosis has been shown but the comparative effects of these variables remain unclear. This study examines the impact of depression, anxiety, vital exhaustion, Type D personality, and social support on prognosis in chronic heart failure patients. One hundred eleven patients (mean age 57 ± 14 years) having participated in an exercise based ambulatory cardiac rehabilitation program were enrolled in a prospective cohort study. Psychological baseline data were assessed at program entry. Mortality, readmission, and health-related quality of life were assessed at follow up (mean 2.8 ± 1.1 years). After controlling for disease severity none of the psychological variables were associated with mortality, though severe anxiety predicted readmission [HR = 3.21 (95% CI, 1.04-9.93; P = .042)]. Health-related quality of life was independently explained by vital exhaustion, anxiety and either body mass index (physical dimension) or sex (emotional dimension). As psychological variables have a strong impact on health-related quality of life they should be routinely assessed in chronic heart failure patients` treatment.