Symptom patterns and clinical outcomes in women versus men with systolic heart failure and depression
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Depression is more common in females than in males and is 3–5 times more prevalent in patients with heart failure (HF) than in the general population. The 9-item Patient Health Questionnaire (PHQ-9) is a validated depression screening instrument; higher sum-scores predict adverse clinical outcomes. Sex- and gender differences in PHQ-9 symptom profile, diagnostic and prognostic properties, and impact on health-related quality of life (HRQOL) have not been comprehensively studied in HF patients.
Methods and results
This post hoc analysis from the Interdisciplinary Network Heart Failure program enrolled 852/1022 participants (67 ± 13 years, 28% female) who completed the PHQ-9 at hospital discharge after cardiac decompensation. All had a left ventricular ejection fraction ≤ 40%. Women had a higher mean PHQ-9 sum-score than men (8.4 ± 5.6 vs. 7.4 ± 5.5; p = 0.027), and higher proportions rated the following items ≥ 2 (i.e., present on ≥ 50% of days): ‘feeling down, hopeless’ (25.8 vs. 18.0%; p = 0.011); ‘fatigue’ (51.9 vs. 37.2%; p < 0.001); and ‘trouble concentrating’ (21.6 vs. 15.4%; p = 0.032). A PHQ-9 sum-score ≥ 10 predicted increased mortality in women [hazard ratio 1.91 (95% confidence interval 1.06–3.43); p = 0.030] and men [2.10 (1.43–3.09); p < 0.001] and was associated with worse HRQOL (p < 0.001 for all comparisons). Sum-scores ≥ 10 predicted higher re-hospitalization rates in men only [1.35 (1.08–1.69); p = 0.008].
Differences in several PHQ-9 items indicated sex- or gender-specific depression symptomatology in HF. For both sexes, HRQOL and survival were worse when PHQ-9 sum-score was ≥ 10, but higher sum-scores predicted higher re-hospitalization rates in men only. Considering these specific aspects might help optimize care strategies in HF.
KeywordsHeart failure Depression Sex Mortality Morbidity
English language editing assistance was provided by Nicola Ryan, BSc, independent medical writer.
This study was funded by the Federal Ministry of Education and Research (BMBF), Grant 01GL0304, by the Competence Network Heart Failure Germany (grants 01GI0205 and 01GI1202A), and by the Comprehensive Heart Failure Center Würzburg (Grants 01EO1004 and 01EO1504).
Compliance with ethical standards
Conflict of interest
None of the authors report any conflicts of interest, including any financial relationship with industry, relevant to this manuscript.
- 6.Meyer S, Teerlink JR, Metra M, Ponikowski P, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH, Hua TA, Severin T, Qian M, Voors AA (2017) Sex differences in early dyspnea relief between men and women hospitalized for acute heart failure: insights from the RELAX-AHF study. Clin Res Cardiol 106:280–292CrossRefPubMedGoogle Scholar
- 8.Murray JLLA (1996) The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Summary. Harvard School of Public Health, World Health Organization, BostonGoogle Scholar
- 15.Lichtman JH, Bigger JT Jr, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lesperance F, Mark DB, Sheps DS, Taylor CB, Froelicher ES (2009) AHA science advisory. Depression and coronary heart disease. Recommendations for screening, referral, and treatment. A science advisory from the American Heart Association Prevention Committee to the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care Outcomes Research. Endorsed by the American Psychiatric Association. Prog Cardiovasc Nurs 24:19–26CrossRefPubMedGoogle Scholar
- 19.Angermann CE, Stork S, Gelbrich G, Faller H, Jahns R, Frantz S, Loeffler M, Ertl G, Competence Network Heart F (2012) Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure: the Interdisciplinary Network for Heart Failure (INH) study. Circ Heart Fail 5:25–35CrossRefPubMedGoogle Scholar
- 24.Faller H, Stork S, Schuler M, Schowalter M, Steinbuchel T, Ertl G, Angermann CE (2009) Depression and disease severity as predictors of health-related quality of life in patients with chronic heart failure—a structural equation modeling approach. J Card Fail 15:286–292 e282CrossRefPubMedGoogle Scholar
- 26.Doyle F, McGee H, Conroy R, Conradi HJ, Meijer A, Steeds R, Sato H, Stewart DE, Parakh K, Carney R, Freedland K, Anselmino M, Pelletier R, Bos EH, de Jonge P (2015) Systematic review and individual patient data meta-analysis of sex differences in depression and prognosis in persons with myocardial infarction: a MINDMAPS study. Psychosom Med 77:419–428CrossRefPubMedGoogle Scholar
- 27.Angermann CE, Gelbrich G, Stork S, Gunold H, Edelmann F, Wachter R, Schunkert H, Graf T, Kindermann I, Haass M, Blankenberg S, Pankuweit S, Prettin C, Gottwik M, Bohm M, Faller H, Deckert J, Ertl G (2016) Effect of escitalopram on all-cause mortality and hospitalization in patients with heart failure and depression: the MOOD-HF randomized clinical trial. Jama 315:2683–2693CrossRefPubMedGoogle Scholar
- 28.O’Connor CM, Jiang W, Kuchibhatla M, Silva SG, Cuffe MS, Callwood DD, Zakhary B, Stough WG, Arias RM, Rivelli SK, Krishnan R (2010) Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial. J Am Coll Cardiol 56:692–699CrossRefPubMedGoogle Scholar
- 29.Heidenreich PA, Spertus JA, Jones PG, Weintraub WS, Rumsfeld JS, Rathore SS, Peterson ED, Masoudi FA, Krumholz HM, Havranek EP, Conard MW, Williams RE, Cardiovascular Outcomes Research C (2006) Health status identifies heart failure outpatients at risk for hospitalization or death. J Am Coll Cardiol 47:752–756CrossRefPubMedGoogle Scholar