Depressive Status And Its Association With Prognosis In Hospitalized Patients With Heart Failure

Background:Heart failure is a major global public health problem.Over the past two decades,the number of deaths from heart failure in China has doubled,reaching 1 million one year,and is still rising rapidly.Depression is an important risk factor and comorbidity of heart failure,which is associated with poor quality of life and reduced clinical treatment compliance.At present,most studies on the association between depression and prognosis of patients with heart failure are concentrated in developed countries,and the conclusions are not consistent.The association between depression changes in baseline to one month after discharge and prognosis in patients with heart failure remains to be studied.The predictive ability of depression screening tools as PHQ-2 and PHQ-8 on the prognosis of heart failure patients is still unclear.Objective:Aim to report the proportion of patients with acute complicated with depression in hospital and 1 month after discharge,explore the correlation between depression in hospital and 1 month after discharge and one-year clinical outcome,explore the correlation between depression change of one month and one-year clinical outcome,and evaluate the predictive ability of PHQ-2 questionnaire and PHQ-8 questionnaire on the outcome of patients with heart failure.To provide theoretical support for the development of routine screening and management of depression for patients with heart failure.Methods:Based on China Patient-Centered Evaluative Assessment of Cardiac Events HF study,we enrolled hospitalized patients with heart failure from August 2016 to May 2018.Baseline information was obtained through questionnaires and medical records.Follow-up was conducted at 1,6 and 12 months after discharge.The preferred interview method is face to face.If the interview cannot be completed,follow up will be conducted by telephone or letter.Baseline information was obtained by collecting questionnaires and medical records.Patients’ clinical outcome events,medication status,physical examination,and ancillary examination were collected during follow-up.The association between depression and change and one-year clinical outcome was assessed using Cox Frailty model,and AUC were used to compare the predictive power of the different models.Results:A total of 4,565 heart failure inpatients completed a depression assessment at baseline and 4,273 completed a depression assessment at one-month follow-up.29.6%of the patients complicated with depression,and 17.4%of the patients complicated with depression 1 month after discharge.At one-month follow-up,33.9%of heart failure patients had improved their depression status,and 12.7%of heart failure patients had deteriorated from baseline.Compared with those without depression,acute heart failure patients with depression had a 40%(HR=1.4,95%CI 1.2-1.6)increased risk of one-year all-cause death.At 1 month after discharge,patients with depression had a 80%(HR=1.8,95%CI 1.5-2.2)and 60%(HR=1.6,95%CI 1.4-1.9)increased risk of 1-year all-cause death and heart failure readmission,respectively.Depression changes in PHQ-2 scores(HR=1.0,95%CI 0.9-1.3)and PHQ-8 scores(HR=1.0,95%CI 0.7-1.5)from hospitalization to 1 month did not predict 1-year clinical outcomes in patients with heart failure.The PHQ-8 performed better than the PHQ-2 in predicting 1-year all-cause death in patients with acute heart failure(P<0.05),and there was no significant difference between PHQ-8 and PHQ-2 in predicting 1-year all-cause death and heart failure readmission at 1 month after discharge(P>0.05).Conclusions:Nearly 30 percent of the patients with heart failure were depressed,and about 1/3 of the patient’ s depression status had ameliorated one month later,while 1/8 of the patient’s depression status had worsening.Patients with acute heart failure who were depressed during hospitalization had an increased risk of all-cause death at 1 year,and depression at 1 month after discharge had an increased risk of all-cause death and heart failure readmission at 1 year.Both PHQ-2 and PHQ-8 can effectively screen for depression,and screening and management of depression in patients with heart failure may improve their prognosis.