Prevalencia de depresión en la cohorte de pacientes de una unidad de insuficiencia cardíaca crónica

Patricia Muñiz Prechac; Pablo Álvarez Rocha; Anaulina Silveira; Gabriela Ormaechea; Gabriela Silvera Pérez

Authors

Patricia Muñiz Prechac Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Unidad Multidisciplinaria de Insuficiencia Cardíaca (UMIC). Médico psiquiatra
Pablo Álvarez Rocha Universidad de la República, Facultad de Medicina, Hospital de Clínicas, UMIC. Coordinador. Profesor Adjunto de Cardiología
Anaulina Silveira Universidad de la República, Facultad de Medicina, Cátedra de Métodos Cuantitativos. Asistente
Gabriela Ormaechea Universidad de la República, Facultad de Medicina, Clínica Médica A. Profesor Agregado
Gabriela Silvera Pérez Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Unidad Multidisciplinaria de Insuficiencia Cardíaca (UMIC). Médico

Keywords:

DEPRESSION, HEART FAILURE, CHRONIC DISEASE

Abstract

Relevance of the topic: depression is a risk factor associated to a greater incidence of coronary pathologies; it is also considered a negative prognostic factor in patients with heart disease. Depression is associated to an increase in the risk of suffering from heart failure in patients who are prone to suffer it, and has negative consequences in those who already suffer from the condition.
Patients with heart failure (HF) and depression evidence greater chances of being hospitalizing and dying. Depression is associated to the severity of the disease in these patients.
The Multidisciplinary Unit of Heart Failure (UMIC) is a program devised to follow up ambulatory patients throughout all stages of the condition.
Objectives: to determine the prevalence of depression in the cohort of patients under follow-up by the Multidisciplinary Unit of Heart Failure (UMIC) and to analyse the potential association of depression with clinical and paraclinical variables: NYHA functional classification (CFNYHA) and left ventricular ejection fraction (LVEF).
Method: transversal descriptive, observational study of 151 patients with HF. Inclusion criteria: belonging to the cohort of patients under follow-up by the Multidisciplinary Unit of Heart Failure (UMIC) (HF for systolic dysfunction with LVEF lower than 40%), being clinically stable and agreeing, by means of a written consent, to being interviewed and undergoing the test. Exclusion criteria: clinical instability due to cardiovascular decompensation elements and cognitive, neurologic or hearing impairments that do not allow for the interview to be conducted.
The test validated by Patients Health Questionnaire 9 (PHQ9) was applied, and the cut off was set in a value ≥ 15 to define depression, with a 0.96 of specificity.
Results: 151 patients were included in the cohort of patients under follow-up by UMIC. The PHQ9 revealed that 29.8% (n=45) showed moderately severe or severe major depression (PHQ9 ≥ 15). Average age of patients with depression was 59.1 ± 1.8 years (20-80 range) and patients with no depression 61.5 ± 1.2 years (25-82 range). There were no statistically significant differences between the groups with and without depression in terms of age.
As to the association of depression and gender and functional classification with depression, no association among variables was found (p=0.287 y p=0.515).
No statistically significant differences were found in the NYHA functional classification according to the presence or absence of depression (p=0.655), neither in the association of LVEF with patients with or without depression (p=0.457).
Conclusions: depression is considered today as a comorbility factor in HF, adding up to 29.8% in the cohort of patients under follow-up by the UMIC. The presence of depression identifies a group of patients with a worse prognosis. We emphasize on the usefulness of the implementation of a simple screening test to identify this condition. The study did not find an association between the presence of depression and age or gender, neither with severity of HF prognosis factors such as the NYHA functional classification of the LVEF. The confirmation of this prevalence values needs to be pointed out given the larger risk the presence of depression implies in patients with HF.

References

(1) Carney RM, Freedland KE. Depression in patients with coronary heart disease. Am J Med 2008; 121(11 Suppl 2):S20-7.
(2) Lett HS, Blumenthal JA, Babyak MA, Sherwood A, Strauman T, Robins C, et al. Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosom Med.2004; 66(3):305-15.
(3) Albert NM, Fonarow GC, Abraham WT, Gheorghiade M, Greenberg BH, Nunez E, et al. Depression and clinical outcomes in heart failure: an OPTIMIZE-HF analysis. Am J Med 2009; 122(4):366-73.
(4) Romero CE. Depresión y enfermedad cardiovascular. Rev Urug Cardiol 2007; 22(2):92-109.
(5) Jiang W, Alexander J, Christopher E, Kuchibhatla M, Gaulden LH, Cuffe MS, et al. Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med 2001; 161(15):1849-56.
(6) Vaccarino V, Kasl SV, Abramson J, Krumholz HM. Depressive symptoms and risk of functional decline and death in patients with heart failure. J Am Coll Cardiol 2001; 38(1):199-205.
(7) Faller H, Störk S, Schowalter M, Steinbüchel T, Wollner V, Ertl G, et al. Depression and survival in chronic heart failure: does gender play a role? Eur J Heart Fail 2007; 9(10):1018-23.
(8) Sherwood A, Blumenthal JA, Trivedi R, Johnson KS, O'Connor CM, Adams KF Jr, et al. Relationship of depression to death or hospitalization in patients with heart failure. Arch Intern Med; 167(4):367-73.
(9) Silver MA. Depression and heart failure: an overview of what we know and don't know. Cleve Clin J Med 2010; 77 Suppl 3:S7-S11.
(10) Gnanasekaran G. Epidemiology of depression in heart failure. Heart Fail Clin 2011; 7(1):1-10.
(11) Pintor L. Insuficiencia cardiaca y enfermedad depresiva, una frecuente combinación tantas veces olvidada. Rev Esp Cardiol 2006; 59(8):761-5.
(12) Lista Varela A, González E. Epidemiología de la depresión 10 años después. Conferencia de la Sociedad de Psiquiatría del Uruguay, mayo 2008; Montevideo (Datos no publicados).
(13) Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999; 282(18):1737-44.
(14) Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16(9):606-13.
(15) Löwe B, Spitzer RL, Gräfe K, Kroenke K, Quenter A, Zipfel S, et al. Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses. J Affect Disord 2004; 78(2):131-40.
(16) Martin A, Rief W, Klaiberg A, Braehler E. Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. Gen Hosp Psychiatry 2006; 28(1):71-7.
(17) Baader T, Molina JL, Venezian S, Rojas C, Farías R, Fierro-Freixenet C, et al. Validación y utilidad de la encuesta PHQ-9 (Patient Health Questionnaire) en el diagnóstico de depresión en pacientes usuarios de atención primaria en Chile. Rev Chil Neuro-psiquiatr 2012; 50(1):10-22. Disponible en: http://www.scielo.cl/scielo.php?HYPERLINK "http://www.scielo.cl/scielo.php?script=sci_arttext&pid= S0717-92272012000100002" script=sci_arttext&pid= S0717-92272012000100002. Consulta: 10 de oct de 2012.
(18) Backenstrass M, Frank A, Joest K, Hingmann S, Mundt C, Kronmüller KT. A comparative study of nonspecific depressive symptoms and minor depression regarding functional impairment and associated characteristics in primary care. Compr Psychiatry 2006; 47(1):35-41.
(19) Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ 2012; 184(3):E191-6.
(20) Löwe B, Kroenke K, Herzog W, Gräfe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord 2004; 81(1):61-6.
(21) Diez-Quevedo C, Rangil T, Sanchez-Planell L, Kroenke K, Spitzer RL. Validation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients. Psychosom Med 2001; 63(4):679-86.
(22) Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol 2006; 48(8):1527-37.
(23) Gottlieb SS, Kop WJ, Ellis SJ, Binkley P, Howlett J, O'Connor C, et al; HF-ACTION Investigators. Relation of depression to severity of illness in heart failure (from Heart Failure And a Controlled Trial Investigating Outcomes of Exercise Training HF-ACTION). Am J Cardiol 2009; 103(9):1285-9.
(24) Gottlieb SS, Khatta M, Friedmann E, Einbinder L, Katzen S, Baker B, et al. The influence of age, gender, and race on the prevalence of depression in heart failure patients. J Am Coll Cardiol 2004; 43(9):1542-9.
(25) Williams SA, Kasl SV, Heiat A, Abramson JL, Krumholz HM, Vaccarino V. Depression and risk of heart failure among the elderly: a prospective community-based study. Psychosom Med 2002; 64(1):6-12.
(26) Naqvi TZ, Naqvi SS, Merz CN. Gender differences in the link between depression and cardiovascular disease. Psychosom Med 2005; 67 (Suppl 1):S15-8.
(27) Skotzko CE, Krichten C, Zietowski G, Alves L, Freudenberger R, Robinson S, et al. Depression is common and precludes accurate assessment of functional status in elderly patients with congestive heart failure. J Card Fail 2000; 6(4):300-5.