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Depressive symptoms and six-year cardiovascular mortality in elderly patients with and without heart failure
Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.ORCID iD: 0000-0001-7431-2873
Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.ORCID iD: 0000-0001-6353-8041
Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
2007 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 41, no 5, 299-307 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate whether depressive symptoms (DS) in elderly patients with heart failure (HF) in the community is associated with increased mortality.

Design: A cohort of 510 elderly patients (65-82 years) in a primary healthcare setting with symptoms associated with HF underwent a clinical and echocardiographic examination. A left ventricular ejection fraction (LVEF) <40% indicated HF. The mental health index scale was used to screen for DS. Cardiovascular and all-cause mortality was registered over 6 years.

Results: After adjustments those with DS had an increased risk (HR) of 3.0 (CI 95% 1.6-5.5, p=0.0001) and 2.2 (CI 95% 1.3-3.7, p=0.0004) of cardiovascular and all-cause mortality, respectively. Patients with HF and DS had the highest risk of cardiovascular mortality, HR 15.7 (CI 95% 4.8-52.2) compared to patients with HF without DS and those with LVEF ≥50% and normal left ventricular diastolic function with and without DS.

Conclusion: DS in elderly patients with HF is independently associated with increased mortality. Screening for DS is recommended as part of the clinical routine in managing patients with HF.

Place, publisher, year, edition, pages
Taylor & Francis Group , 2007. Vol. 41, no 5, 299-307 p.
Keyword [en]
Heart failure, depressive symptoms, mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-15782DOI: 10.1080/14017430701534829OAI: oai:DiVA.org:liu-15782DiVA: diva2:127272
Available from: 2008-12-04 Created: 2008-12-03 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Health‐related quality of life, depression, sleep and breathing disorders in the elderly: With focus on those with impaired systolic function/heart failure
Open this publication in new window or tab >>Health‐related quality of life, depression, sleep and breathing disorders in the elderly: With focus on those with impaired systolic function/heart failure
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe the prevalence of depressive symptoms, sleep disordered breathing (SDB) and sleep complaints, as well as to investigate the prognostic value of health-related quality of life (Hr-QoL) and depressive symptoms on mortality in an elderly community living population with a focus on those with impaired systolic function/heart failure (HF). Descriptive, prognostic and explorative study designs were used to examine if a single question about global perceived health (GPH) is associated with the domains of Hr-QoL as assessed by the SF-36 (I), as well as to evaluate whether GPH provided prognostic information concerning cardiovascular mortality (II). The aim was also to evaluate if depressive symptoms are associated with mortality (III), and to describe the prevalence of SDB and its relationship to impaired systolic function, different insomnia symptoms, as well as excessive daytime sleepiness (IV).

In primary care elderly patients with HF, GPH correlated to the physical and mental aspects of Hr-QoL. Patients who rated poor GPH also scored worse physical and mental Hr-QoL compared to patients with good GPH, but the mental aspect of Hr-QoL was however not significant (p<0.07) (I). Moreover, GPH also had an independent association with cardiovascular mortality during a ten-year follow-up. Compared to patients with good GPH, those who scored poor GPH had a four times increased risk for cardiovascular mortality (II). A total of 24% of the patients with HF suffered from depressive symptoms, not significantly different compared to 19% among those without HF. Depressive symptoms were a poor prognostic sign during the six-year follow-up and HF patients with depressive symptoms had the highest risk for cardiovascular mortality compared to HF patients without depressive symptoms (III). SDB is common among elderly people living in the community, almost one quarter (23%) had moderate or severe SDB. However, people with moderate impaired systolic function had a median apnea hypopnea index that was more than twice as high compared to those with normal systolic function (10.9 vs. 5.0, p<0.001). No obvious associations between SDB and excessive daytime sleepiness or the insomnia symptoms; difficulties maintaining sleep; non-restorative sleep; or early morning awakenings were detected. Difficulties initiating sleep were however more common in those with moderate or severe SDB (IV).

GPH can be used as a simple tool in clinical routine practice as an aid in identifying patients in need of additional management. SDB is a common phenomenon among elderly people and associated with impaired systolic function, but with a limited impact on subjective sleep complaints. Depressive symptoms were shown to be a poor prognostic sign and may amplify the patient’s experience of suffering. Screening for depressive symptoms could therefore be an important action in the management of patients with HF.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2008. 62 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1089
Keyword
Elderly, cardiac function, chronic heart failure, health-related quality of life, depressive symptoms, prognosis, sleep disturbances, sleep disordered breathing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-15784 (URN)978-91-7393-749-8 (ISBN)
Public defence
2008-12-19, Berzelius salen, Campus US, Hälsouniversitetet, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2008-12-03 Created: 2008-12-03 Last updated: 2013-09-26Bibliographically approved

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Johansson, PeterDahlström, UlfAlehagen, Urban

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