Depression and Clinical Outcomes in Heart Failure: An OPTIMIZE-HF Analysis

Hospitalized patients with heart failure and a history of depression were less likely to receive cardiac procedures and some education components during hospitalization, and referral to an outpatient heart failure disease management program at discharge. Hospital length of stay was longer and all-cause mortality was higher in patients with a history of depression.

Abstract
Background
Depression is a risk factor of excessive morbidity and mortality in heart failure. We examined in-hospital treatment and postdischarge outcomes in hospitalized heart failure patients with a documented history of depression from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure.

Methods
We identified patient factors associated with depression history and evaluated the association of depression with hospital treatments and mortality, and early postdischarge mortality, emergency care, and rehospitalization.

Results
In 48,612 patients from 259 hospitals, depression history was present in 10.6% and occurred more often in females, whites, and those with common heart failure comorbidities, including chronic pulmonary obstructive disease (36% vs 27%), anemia (27% vs 16.5%), insulin-dependent diabetes mellitus (20% vs 16%), and hyperlipidemia (38% vs 31%), all P <.001. Patients with depression history were less likely to receive coronary interventions and cardiac devices, all P <.01; or be referred to outpatient disease management programs, P <.001. Length of hospital stay was longer with depression history (7.0 vs 6.4 days, P <.001). In 5791 patients followed-up at 60-90 days postdischarge, those with depression history had higher mortality (8.8% vs 6.4%; P = .025). After multivariable modeling, depression history remained a predictor of length of hospital stay, P <.001 and postdischarge mortality, P = .02.

Conclusions
Depression history at heart failure hospitalization may be a predictor of prolonged length of hospital stay, less use of cardiac procedures and postdischarge disease management, and increased 60-90 day mortality. Patients with depression might represent a vulnerable group in which improved use of evidence-based treatment should be considered.

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-- Nancy M. Albert, PhD, Gregg C. Fonarow, MD, William T. Abraham, MD, Mihai Gheorghiade, MD, Barry H. Greenberg, MD, Eduardo Nunez, MD, Christopher M. O'Connor, MD, Wendy G. Stough, PharmD, Clyde W. Yancy, MD, James B. Young, MD

This article was originally published in the April 2009 issue of The American Journal of Medicine.