By Liam O'Neil, Heart Failure 2015, Seville, Spain

Moderate to severe depression is associated with a 5-fold increased risk of all cause mortality in patients with heart failure, according to research presented today at Heart Failure 2015.

The results from OPERA-HF presented at Heart Failure 2015 today, showed that risk was independent of comorbidities and severity of heart failure. Patients who were not depressed had an 80% lower mortality risk.

Professor John Cleland, chief investigator of OPERA-HF and professor of cardiology at Imperial College London and the University of Hull, UK, said: “OPERA-HF was designed to investigate in a more holistic fashion than previously the predictors of and reasons for readmission and death amongst patients with heart failure. This included social, mental and physical frailty, as well as comorbidities and the severity of heart failure. Depression has been reported to predict death in patients with heart failure but until now it was thought that this could be because depressed patients have more severe heart failure and more comorbidities.”

In the study, researchers examined heart failure patients over 302 days; 103 patients weren’t depressed, 27 had mild depression, and 24 had moderate to severe depression. OPERA-HF is an ongoing observational study enrolling patients hospitalised with heart failure. Depression was assessed using the Hospital Anxiety and Depression Scale (HADS-D) questionnaire and comorbidity was examined using the Charlson Comorbidity Index (CCI). Over the course of 302 days, 27 patients died. It transpired that those with moderate to severe depression were five times more likely to die than patients with little to no depression compared to those with no or mild depression.

Moderate to severe depression remained an important predictor of all-cause mortality even after controlling for sex, age, hypertension, severity of heart failure (assessed by NT-proBNP) and comorbidities. Patients with a low HADS-D score (0-7) had an 80% lower risk of death.

Professor Cleland said: “Our results show that depression is strongly associated with death during the year following discharge from hospital after an admission for the exacerbation of heart failure; we expect that the link persists beyond one year. The association was independent of the severity of heart failure or the presence of comorbidities.”

He added: “We know that depression is common in heart failure and affects 20-40% of patients. Depression is often related to loss of motivation, loss of interest in everyday activities, lower quality of life, loss of confidence, sleep disturbances and change in appetite with corresponding weight change. This could explain the association we found between depression and mortality.”

Professor Cleland concluded: “Our research clearly shows a strong association between depression and risk of death in the year after discharge from hospital. Recognition and management of depression may reduce mortality for patients with heart failure. More research is needed to find out what clinicians and patients themselves can do to manage depression. Better treatments for heart failure, co-morbidities as well as depression itself may be required.”