Diabetes and Depression Linked With Adverse Outcomes in HF
Diabetes and Depression Linked With Adverse Outcomes in HF
Background: More than 22% of individuals with diabetes mellitus have concomitant heart failure (HF), and the prevalence of diabetes in those with HF is nearly triple that of individuals without HF. Comorbid depressive symptoms are common in diabetes and HF. Depressive symptoms are an independent predictor of mortality in individuals with diabetes alone, as well as those with HF alone and are a predictor of rehospitalization in those with HF. However, the association of comorbid HF, diabetes and depressive symptoms with all-cause mortality and rehospitalization for cardiac causes has not been determined.
Objective: The purpose of this study was to evaluate the association of comorbid HF, diabetes and depression with all-cause mortality and rehospitalization for cardiac cause.
Method: Patients provided data at baseline about demographic and clinical variables and depressive symptoms; patients were followed for at least 2 years. Participants were divided into four groups based on the presence and absence of diabetes and depressive symptoms. Cox regression analysis was used to determine whether comorbid diabetes and depressive symptoms independently predicted all-cause mortality and cardiac rehospitalization in these patients with HF.
Results: Patients (n=663) were primarily male (69%), white (76%), and aged 61±13 years. All-cause mortality was independently predicted by the presence of concomitant diabetes and depressive symptoms (HR 3.71; 95% CI 1.49 to 9.25; p=0.005), and depressive symptoms alone (HR 2.29; 95% CI 0.94 to 5.40; p=0.05). The presence of comorbid diabetes and depressive symptoms was also an independent predictor of cardiac rehospitalization (HR 2.36; 95% CI 1.27 to 4.39; p=0.007).
Conclusions: Comorbid diabetes and depressive symptoms are associated with poorer survival and rehospitalization in patients with HF; effective strategies to regularly evaluate and effectively manage these comorbid conditions are necessary to improve survival and reduce rehospitalization rates.
Nearly 30 million adult Americans, or approximately 12% of the adult population of the USA, has diabetes; the cost of care for these individuals totaled $245 billion in 2012. Cardiovascular disease is the primary cause of death for individuals with diabetes, and diabetes significantly increases the risk for development of hypertension and dyslipidaemia, two major risk factors for cardiovascular disease. The prevalence of diabetes in individuals with heart failure (HF) ranges from 24% (in those with chronic HF) to 40% (in hospitalized patients with worsening HF). In those with diabetes, the risk for acute coronary syndrome is increased by 80%, risk for stroke by 50%, and risk for cardiac death by 70%. Thus, comorbid diabetes and HF confer a significant risk of cardiovascular morbidity and mortality.
The presence of depressive symptoms and major depression are also associated with greater risk of morbidity and mortality in individuals with HF. Suzuki et al found that depressive symptoms in individuals with HF more than doubled the likelihood of mortality (OR 2.24, CI 1.17 to 4.28, p=0.01), while Fan et al reported that depression nearly doubled the risk for mortality (HR 1.98, CI 1.23 to 3.19). Individuals with diabetes are also at increased risk for depression. Roy et al reported that depression prevalence ranged from 15% to 66% in individuals with diabetes. Depression and comorbid diabetes were associated with a nearly 50% increase in mortality. Depression has also been associated with worse self-care, poorer quality of life, higher healthcare costs and greater mortality in those with HF and diabetes.
Although there have been prior studies of these associations in individuals with diabetes alone and HF alone, the association of comorbid HF, diabetes and depressive symptoms in individuals with all-cause mortality and rehospitalization for cardiac cause has not been systematically investigated. Thus, the purpose of this study was to examine whether comorbid depressive symptoms and diabetes were associated with all-cause mortality or rehospitalization for cardiac causes in patients with HF.
Abstract and Introduction
Abstract
Background: More than 22% of individuals with diabetes mellitus have concomitant heart failure (HF), and the prevalence of diabetes in those with HF is nearly triple that of individuals without HF. Comorbid depressive symptoms are common in diabetes and HF. Depressive symptoms are an independent predictor of mortality in individuals with diabetes alone, as well as those with HF alone and are a predictor of rehospitalization in those with HF. However, the association of comorbid HF, diabetes and depressive symptoms with all-cause mortality and rehospitalization for cardiac causes has not been determined.
Objective: The purpose of this study was to evaluate the association of comorbid HF, diabetes and depression with all-cause mortality and rehospitalization for cardiac cause.
Method: Patients provided data at baseline about demographic and clinical variables and depressive symptoms; patients were followed for at least 2 years. Participants were divided into four groups based on the presence and absence of diabetes and depressive symptoms. Cox regression analysis was used to determine whether comorbid diabetes and depressive symptoms independently predicted all-cause mortality and cardiac rehospitalization in these patients with HF.
Results: Patients (n=663) were primarily male (69%), white (76%), and aged 61±13 years. All-cause mortality was independently predicted by the presence of concomitant diabetes and depressive symptoms (HR 3.71; 95% CI 1.49 to 9.25; p=0.005), and depressive symptoms alone (HR 2.29; 95% CI 0.94 to 5.40; p=0.05). The presence of comorbid diabetes and depressive symptoms was also an independent predictor of cardiac rehospitalization (HR 2.36; 95% CI 1.27 to 4.39; p=0.007).
Conclusions: Comorbid diabetes and depressive symptoms are associated with poorer survival and rehospitalization in patients with HF; effective strategies to regularly evaluate and effectively manage these comorbid conditions are necessary to improve survival and reduce rehospitalization rates.
Introduction
Nearly 30 million adult Americans, or approximately 12% of the adult population of the USA, has diabetes; the cost of care for these individuals totaled $245 billion in 2012. Cardiovascular disease is the primary cause of death for individuals with diabetes, and diabetes significantly increases the risk for development of hypertension and dyslipidaemia, two major risk factors for cardiovascular disease. The prevalence of diabetes in individuals with heart failure (HF) ranges from 24% (in those with chronic HF) to 40% (in hospitalized patients with worsening HF). In those with diabetes, the risk for acute coronary syndrome is increased by 80%, risk for stroke by 50%, and risk for cardiac death by 70%. Thus, comorbid diabetes and HF confer a significant risk of cardiovascular morbidity and mortality.
The presence of depressive symptoms and major depression are also associated with greater risk of morbidity and mortality in individuals with HF. Suzuki et al found that depressive symptoms in individuals with HF more than doubled the likelihood of mortality (OR 2.24, CI 1.17 to 4.28, p=0.01), while Fan et al reported that depression nearly doubled the risk for mortality (HR 1.98, CI 1.23 to 3.19). Individuals with diabetes are also at increased risk for depression. Roy et al reported that depression prevalence ranged from 15% to 66% in individuals with diabetes. Depression and comorbid diabetes were associated with a nearly 50% increase in mortality. Depression has also been associated with worse self-care, poorer quality of life, higher healthcare costs and greater mortality in those with HF and diabetes.
Although there have been prior studies of these associations in individuals with diabetes alone and HF alone, the association of comorbid HF, diabetes and depressive symptoms in individuals with all-cause mortality and rehospitalization for cardiac cause has not been systematically investigated. Thus, the purpose of this study was to examine whether comorbid depressive symptoms and diabetes were associated with all-cause mortality or rehospitalization for cardiac causes in patients with HF.
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