Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure

Background: Patients with congestive heart failure (CHF) may have a high pr evalence of depression, which may increase the risk of adverse outcomes. Objective: To determine the prevalence and relationship of depression to ou tcomes of patients hospitalized with CHF. Methods: We screened patients aged 18 years or older having New York Heart Association class II or greater CHF, an ejection fraction of 35% or less, o r both, admitted between March 1, 1997, and June 30, 1998, to the cardiolog y service of one hospital. Patients with a Beck Depression Inventory score of 10 or higher underwent a modified National Institute of Mental Health Di agnostic Interview Schedule to identify major depressive disorder. Primary care providers coordinated standard treatment for CHF and other medical and psychiatric disorders. We assessed all-cause mortality and readmission (re hospitalization) rates 3 months and 1 year after depression assessment. Log istic regression analyses were used to evaluate the independent prognostic value of depression after adjustment for clinical risk factors. Results: Of 374 patients screened, 35.3% had a Beck Depression Inventory sc ore of 10 or higher and 13.9% had major depressive disorder. Overall mortal ity was 7.9% at 3 months and 16.2% at I year. Major depression was associat ed with increased mortality at 3 months (odds ratio, 2.5 vs no depression; P = .08) and at 1 year (odds ratio, 2.23; P = .04) and readmission at 3 mon ths (odds ratio, 1.90; P = .04) and at 1 year (odds ratio, 3.07; P = .005). These increased risks were independent of age, New York Heart Association class, baseline ejection fraction, and ischemic etiology of CHF. Conclusions: Major depression is common in patients hospitalized with CHF a nd is independently associated with a poor prognosis.