The
Cardiomyopathy
Association

Researchers in America have called for people with heart failure to have screening for depression following a study which shows patients with worsening depressive symptoms are at increased risk of being admitted to hospital or dying.

The observational study, published this month in the Journal of the American College of Cardiology, shows that heart failure patients with the most marked increase in depression over a one-year period had more than twice the risk of being admitted to hospital or dying compared with patients with minimal change or improvements in their depression.

"To our knowledge, this is the first study to evaluate the clinical impact of changing depression symptoms in heart failure patients, and our observations demonstrate that such changes do indeed affect clinical outcomes," said Dr Andrew Sherwood  from the Duke University Medical Centre, Durham, New York City.
 
The paper noted that clinical depression affected  between 24 and 42 per cent of patients.

To examine this issue, investigators assessed the depressive symptoms of 147 heart failure patients with an ejection fraction of less than 40 per cent.  Being in hospital for a heart attack, stroke, treatment for worsening heart failure and cardiac surgery were included.

Participants had a median age of 57 and their medical records were reviewed annually for a median of five years by research assistants blinded to patients' depression status.

The investigators found increasing depressive symptoms were associated with a trend towards an increased risk of hospitalisation or death.

They reported: "Our findings support the recent American Heart Association's position enouraging depression screening and further suggest that it may be prudent for clinicians to reassess symptoms of depression routinely in heart failure patients to determine better appropriate medical management of these patients who are at increased risk for adverse clinical outcomes and impaired quality of life,"

They added that there was a need for randomised clinical trials of antidepressant therapy in heart failure patients to determine whether such therapy could improve outcomes.