nach oben

Quality of Life Research

Erschienen in:

01.08.2014

Depressive symptoms, health-related quality of life, and cardiac event-free survival in patients with heart failure: a mediation analysis

verfasst von: Kyoung Suk Lee, Terry A. Lennie, Jia-Rong Wu, Martha J. Biddle, Debra K. Moser

Erschienen in: Quality of Life Research | Ausgabe 6/2014

Einloggen

Aktivieren Sie unsere intelligente Suche, um passende Fachinhalte oder Patente zu finden.

search-config

KI-gestützte Suche

Aus

Abstract

Purpose

Health-related quality of life (HRQOL) and depressive symptoms both are associated with an adverse prognosis in heart failure (HF), although their associations with outcomes have been examined only in isolation. Therefore, it is unknown how HRQOL and depressive symptoms might interact in their associations with outcomes. The present study was conducted to determine whether the association between HRQOL and cardiac event-free survival is mediated by depressive symptoms in HF patients given that depressive symptoms are associated strongly with HRQOL.

Methods

A total of 209 HF patients (61 ± 11 years, 24 % female, 49 % NYHA III/IV) participated. The Minnesota Living with HF Questionnaire and the Patient Health Questionnaire-9 were used to measure HRQOL and depressive symptoms, respectively. Patients were followed for a median of 357 days to determine cardiac event-free survival.

Results

In Cox regression analysis, HRQOL [hazard ratio (HR) 1.013; 95 % confidence interval (CI) 1.001–1.026] and depressive symptoms (HR 1.075; 95 % CI 1.025–1.127) predicted cardiac event-free survival separately, controlling for demographic and clinical variables. HRQOL independently explained 38.7 % of the variance in depressive symptoms (p < 0.05; standardized β = 0.695) in a multiple regression. When HRQOL and depressive symptoms were entered in the model simultaneously, only depressive symptoms independently predicted cardiac event-free survival (HR 1.068; 95 % CI 1.001–1.139), demonstrating a mediation effect of depressive symptoms.

Conclusions

Depressive symptoms mediated the relationship between HRQOL and cardiac event-free survival. Interventions targeting HRQOL to enhance patient outcomes must also address patient depressive symptoms to be fully efficacious.

Vorheriger Artikel Impact of autism in adolescents on parental quality of life

Nächster Artikel Health-related quality of life of children and adolescents with functional disabilities in a northern Swedish county

Sie haben noch keine Lizenz? Dann Informieren Sie sich jetzt über unsere Produkte:

Springer Professional "Wirtschaft+Technik"

Online-Abonnement

Mit Springer Professional "Wirtschaft+Technik" erhalten Sie Zugriff auf:

über 102.000 Bücher
über 537 Zeitschriften

aus folgenden Fachgebieten:

Automobil + Motoren
Bauwesen + Immobilien
Business IT + Informatik
Elektrotechnik + Elektronik
Energie + Nachhaltigkeit
Finance + Banking
Management + Führung
Marketing + Vertrieb
Maschinenbau + Werkstoffe
Versicherung + Risiko

Jetzt Wissensvorsprung sichern!

Jetzt informieren

Springer Professional "Wirtschaft"

Online-Abonnement

Mit Springer Professional "Wirtschaft" erhalten Sie Zugriff auf:

über 67.000 Bücher
über 340 Zeitschriften

aus folgenden Fachgebieten:

Bauwesen + Immobilien
Business IT + Informatik
Finance + Banking
Management + Führung
Marketing + Vertrieb
Versicherung + Risiko

Jetzt Wissensvorsprung sichern!

Jetzt informieren

Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Borden, W. B., et al. (2013). Heart disease and stroke statistics–2013 update: A report from the American Heart Association. Circulation, 127(1), e6–e245.PubMedCrossRef

Greiner, M. A., Hammill, B. G., Fonarow, G. C., Whellan, D. J., Eapen, Z. J., Hernandez, A. F., et al. (2012). Predicting costs among medicare beneficiaries with heart failure. American Journal of Cardiology, 109(5), 705–711.PubMedCentralPubMedCrossRef

Heo, S., Lennie, T. A., Okoli, C., & Moser, D. K. (2009). Quality of life in patients with heart failure: Ask the patients. Heart and Lung, 2, 100–108.CrossRef

Alla, F., Briancon, S., Guillemin, F., Juilliere, Y., Mertes, P. M., Villemot, J. P., et al. (2002). Self-rating of quality of life provides additional prognostic information in heart failure. Insights into the EPICAL study. European Journal of Heart Failure, 4(3), 337–343.PubMedCrossRef

Lesman-Leegte, I., Jaarsma, T., Coyne, J. C., Hillege, H. L., Van Veldhuisen, D. J., & Sanderman, R. (2009). Quality of life and depressive symptoms in the elderly: A comparison between patients with heart failure and age- and gender-matched community controls. Journal of Cardiac Failure, 15(1), 17–23.PubMedCrossRef

Heo, S., Moser, D. K., Lennie, T. A., Zambroski, C. H., & Chung, M. L. (2007). A comparison of health-related quality of life between older adults with heart failure and healthy older adults. Heart and Lung, 36(1), 16–24.PubMedCrossRef

Hobbs, F. D., Kenkre, J. E., Roalfe, A. K., Davis, R. C., Hare, R., & Davies, M. K. (2002). Impact of heart failure and left ventricular systolic dysfunction on quality of life: A cross-sectional study comparing common chronic cardiac and medical disorders and a representative adult population. European Heart Journal, 23(23), 1867–1876.PubMedCrossRef

Lupon, J., Gastelurrutia, P., de Antonio, M., Gonzalez, B., Cano, L., Cabanes, R., et al. (2013). Quality of life monitoring in ambulatory heart failure patients: Temporal changes and prognostic value. European Journal of Heart Failure, 15(1), 103–109.PubMedCrossRef

Parissis, J. T., Nikolaou, M., Farmakis, D., Paraskevaidis, I. A., Bistola, V., Venetsanou, K., et al. (2009). Self-assessment of health status is associated with inflammatory activation and predicts long-term outcomes in chronic heart failure. European Journal of Heart Failure, 11(2), 163–169.PubMedCentralPubMedCrossRef

10.

Moser, D. K., Yamokoski, L., Sun, J. L., Conway, G. A., Hartman, K. A., Graziano, J. A., et al. (2009). Improvement in health-related quality of life after hospitalization predicts event-free survival in patients with advanced heart failure. Journal of Cardiac Failure, 15(9), 763–769.PubMedCentralPubMedCrossRef

11.

Havranek, E. P., Spertus, J. A., Masoudi, F. A., Jones, P. G., & Rumsfeld, J. S. (2004). Predictors of the onset of depressive symptoms in patients with heart failure. Journal of the American College of Cardiology, 44(12), 2333–2338.PubMedCrossRef

12.

Adams, J., Kuchibhatla, M., Christopher, E. J., Alexander, J. D., Clary, G. L., Cuffe, M. S., et al. (2012). Association of depression and survival in patients with chronic heart failure over 12 years. Psychosomatics, 53(4), 339–346.PubMedCentralPubMedCrossRef

13.

Lesman-Leegte, I., van Veldhuisen, D. J., Hillege, H. L., Moser, D., Sanderman, R., & Jaarsma, T. (2009). Depressive symptoms and outcomes in patients with heart failure: Data from the COACH study. European Journal of Heart Failure, 11(12), 1202–1207.PubMedCrossRef

14.

Lee, K. S., Lennie, T. A., Heo, S., & Moser, D. K. (2012). Association of physical versus affective depressive symptoms with cardiac event-free survival in patients with heart failure. Psychosomatic Medicine, 74(5), 452–458.PubMedCentralPubMedCrossRef

15.

Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H., & Mills, P. J. (2006). Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. Journal of the American College of Cardiology, 48(8), 1527–1537.PubMedCrossRef

16.

Murberg, T. A., Bru, E., Svebak, S., Tveteras, R., & Aarsland, T. (1999). Depressed mood and subjective health symptoms as predictors of mortality in patients with congestive heart failure: A two-years follow-up study. International Journal of Psychiatry in Medicine, 29(3), 311–326.PubMedCrossRef

17.

Rector, T. S., Kubo, S. H., & Cohn, J. N. (1987). Patients’ self-assessment of their congestive heart failure, Part 2: Content, reliability and validity of a new measure, the Minnesota Living with Heart Failure Questionnaire. Heart Failure, 3, 198–209.

18.

Rector, T. S., & Cohn, J. N. (1992). Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: Reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. American Heart Journal, 124(4), 1017–1025.PubMedCrossRef

19.

Heo, S., Moser, D. K., Riegel, B., Hall, L. A., & Christman, N. (2005). Testing the psychometric properties of the Minnesota Living with Heart Failure questionnaire. Nursing Research, 54(4), 265–272.PubMedCrossRef

20.

Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). 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. The Journal of the American Medical Association, 282(18), 1737–1744.CrossRef

21.

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.PubMedCentralPubMedCrossRef

22.

McManus, D., Pipkin, S. S., & Whooley, M. A. (2005). Screening for depression in patients with coronary heart disease (data from the Heart and Soul Study). American Journal of Cardiology, 96(8), 1076–1081.PubMedCentralPubMedCrossRef

23.

Hammash, M. H., Hall, L. A., Lennie, T. A., Heo, S., Chung, M. L., Lee, K. S., et al. (2013). Psychometrics of the PHQ-9 as a measure of depressive symptoms in patients with heart failure. European Journal of Cardiovascular Nursing, 12(5), 446–453.PubMedCrossRef

24.

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373–383.PubMedCrossRef

25.

Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.PubMedCrossRef

26.

Behlouli, H., Feldman, D. E., Ducharme, A., Frenette, M., Giannetti, N., Grondin, F., et al. (2009) Identifying relative cut-off scores with neural networks for interpretation of the Minnesota Living with Heart Failure questionnaire. In Conference proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Conference, pp. 6242–6246.

27.

Brannstrom, M., Ekman, I., Norberg, A., Boman, K., & Strandberg, G. (2006). Living with severe chronic heart failure in palliative advanced home care. European Journal Cardiovascular Nursing, 5(4), 295–302.CrossRef

28.

Bosworth, H. B., Steinhauser, K. E., Orr, M., Lindquist, J. H., Grambow, S. C., & Oddone, E. Z. (2004). Congestive heart failure patients’ perceptions of quality of life: The integration of physical and psychosocial factors. Aging & Mental Health, 8(1), 83–91.CrossRef

29.

Stanek, E. J., Oates, M. B., McGhan, W. F., Denofrio, D., & Loh, E. (2000). Preferences for treatment outcomes in patients with heart failure: Symptoms versus survival. Journal of Cardiac Failure, 6(3), 225–232.PubMedCrossRef

30.

Mommersteeg, P. M., Kupper, N., Schoormans, D., Emons, W., & Pedersen, S. S. (2010). Health-related quality of life is related to cytokine levels at 12 months in patients with chronic heart failure. Brain, Behavior, and Immunity, 24(4), 615–622.PubMedCrossRef

31.

Pasic, J., Levy, W. C., & Sullivan, M. D. (2003). Cytokines in depression and heart failure. Psychosomatic Medicine, 65(2), 181–193.PubMedCrossRef

32.

Johansson, P., Lesman-Leegte, I., Lundgren, J., Hillege, H. L., Hoes, A., Sanderman, R., et al. (2013). Time-course of depressive symptoms in patients with heart failure. Journal of Psychosomatic Research, 74(3), 238–243.PubMedCrossRef

33.

Sun, F., Park, N. S., Roff, L. L., Klemmack, D. L., Parker, M., Koenig, H. G., et al. (2012). Predicting the trajectories of depressive symptoms among southern community-dwelling older adults: The role of religiosity. Aging & Mental Health, 16(2), 189–198.CrossRef

34.

Shimizu, Y., Yamada, S., Miyake, F., Izumi, T., & Collaborators, P. T. (2011). The effects of depression on the course of functional limitations in patients with chronic heart failure. Journal of Cardiac Failure, 17(6), 503–510.PubMedCrossRef

35.

Dekker, R. L., Lennie, T. A., Albert, N. M., Rayens, M. K., Chung, M. L., Wu, J. R., et al. (2011). Depressive symptom trajectory predicts 1-year health-related quality of life in patients with heart failure. Journal of Cardiac Failure, 17(9), 755–763.PubMedCentralPubMedCrossRef

36.

Muller-Tasch, T., Peters-Klimm, F., Schellberg, D., Holzapfel, N., Barth, A., Junger, J., et al. (2007). Depression is a major determinant of quality of life in patients with chronic systolic heart failure in general practice. Journal of Cardiac Failure, 13(10), 818–824.PubMedCrossRef

37.

Rhodes, D. L., & Bowles, C. L. (2002). Heart failure and its impact on older women’s lives. Journal of Advanced Nursing, 39(5), 441–449.PubMedCrossRef

38.

Hopp, F. P., Thornton, N., Martin, L., & Zalenski, R. (2012). Life disruption, life continuation: Contrasting themes in the lives of African-American elders with advanced heart failure. Social Work in Health Care, 51(2), 149–172.PubMedCrossRef

39.

Faller, H., Stork, S., Schuler, M., Schowalter, M., Steinbuchel, T., Ertl, G., et al. (2009). Depression and disease severity as predictors of health-related quality of life in patients with chronic heart failure-A structural equation modeling approach. Journal of Cardiac Failure, 15(4), 286–292.PubMedCrossRef

40.

Gary, R. A., Sueta, C. A., Dougherty, M., Rosenberg, B., Cheek, D., Preisser, J., et al. (2004). Home-based exercise improves functional performance and quality of life in women with diastolic heart failure. Heart and Lung, 33(4), 210–218.PubMedCrossRef

41.

Huffman, J. C., Mastromauro, C. A., Sowden, G., Fricchione, G. L., Healy, B. C., & Januzzi, J. L. (2011). Impact of a depression care management program for hospitalized cardiac patients. Circulation, 4(2), 198–205.PubMed

42.

Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J., & Ten Have, T. (2012). Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: A randomized controlled trial. Gerontologist, 52(4), 541–552.PubMedCrossRef

43.

Tsutamoto, T., Hisanaga, T., Wada, A., Maeda, K., Ohnishi, M., Fukai, D., et al. (1998). Interleukin-6 spillover in the peripheral circulation increases with the severity of heart failure, and the high plasma level of interleukin-6 is an important prognostic predictor in patients with congestive heart failure. Journal of the American College of Cardiology, 31(2), 391–398.PubMedCrossRef

44.

Deswal, A., Petersen, N. J., Feldman, A. M., Young, J. B., White, B. G., & Mann, D. L. (2001). Cytokines and cytokine receptors in advanced heart failure: An analysis of the cytokine database from the Vesnarinone trial (VEST). Circulation, 103(16), 2055–2059.PubMedCrossRef

45.

Parissis, J. T., Fountoulaki, K., Paraskevaidis, I., & Kremastinos, D. (2005). Depression in chronic heart failure: Novel pathophysiological mechanisms and therapeutic approaches. Expert Opinion on Investigational Drugs, 14(5), 567–577.PubMedCrossRef

46.

Paukert, A. L., LeMaire, A., & Cully, J. A. (2009). Predictors of depressive symptoms in older veterans with heart failure. Aging & Mental Health, 13(4), 601–610.CrossRef

47.

Bauer, L. K., Caro, M. A., Beach, S. R., Mastromauro, C. A., Lenihan, E., Januzzi, J. L., et al. (2012). Effects of depression and anxiety improvement on adherence to medication and health behaviors in recently hospitalized cardiac patients. American Journal of Cardiology, 109(9), 1266–1271.PubMedCrossRef

48.

Luyster, F. S., Hughes, J. W., & Gunstad, J. (2009). Depression and anxiety symptoms are associated with reduced dietary adherence in heart failure patients treated with an implantable cardioverter defibrillator. Journal of Cardiovascular Nursing, 24(1), 10–17.PubMedCrossRef

49.

Lee, C. S., Moser, D. K., Lennie, T. A., & Riegel, B. (2011). Event-free survival in adults with heart failure who engage in self-care management. Heart and Lung, 40(1), 12–20.PubMedCentralPubMedCrossRef

50.

Lennie, T. A., Song, E. K., Wu, J. R., Chung, M. L., Dunbar, S. B., Pressler, S. J., et al. (2011). Three gram sodium intake is associated with longer event-free survival only in patients with advanced heart failure. Journal of Cardiac Failure, 17(4), 325–330.PubMedCentralPubMedCrossRef

51.

O’Connor, C. M., Jiang, W., Kuchibhatla, M., Silva, S. G., Cuffe, M. S., Callwood, D. D., et al. (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. Journal of American College Cardiology, 56(9), 692–699.CrossRef

52.

Flynn, K. E., Pina, I. L., Whellan, D. J., Lin, L., Blumenthal, J. A., Ellis, S. J., et al. (2009). Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. The Journal of the American Medical Association, 301(14), 1451–1459.CrossRef

53.

Blumenthal, J. A., Babyak, M. A., O’Connor, C., Keteyian, S., Landzberg, J., Howlett, J., et al. (2012). Effects of exercise training on depressive symptoms in patients with chronic heart failure: The HF-ACTION randomized trial. The Journal of the American Medical Association, 308(5), 465–474.CrossRef

54.

O’Connor, C. M., Whellan, D. J., Lee, K. L., Keteyian, S. J., Cooper, L. S., Ellis, S. J., et al. (2009). Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. The Journal of the American Medical Association, 301(14), 1439–1450.CrossRef

55.

Howie-Esquivel, J., & Dracup, K. (2007). Effect of gender, ethnicity, pulmonary disease, and symptom stability on rehospitalization in patients with heart failure. American Journal of Cardiology, 100(7), 1139–1144.PubMedCrossRef

56.

Evangelista, L. S., Dracup, K., & Doering, L. V. (2002). Racial differences in treatment-seeking delays among heart failure patients. Journal of Cardiac Failure, 8(6), 381–386.PubMedCrossRef

57.

Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12(1), 23–44.PubMedCrossRef

Titel: Depressive symptoms, health-related quality of life, and cardiac event-free survival in patients with heart failure: a mediation analysis
verfasst von: Kyoung Suk Lee
Terry A. Lennie
Jia-Rong Wu
Martha J. Biddle
Debra K. Moser
Publikationsdatum: 01.08.2014
Verlag: Springer International Publishing
Erschienen in: Quality of Life Research / Ausgabe 6/2014
Print ISSN: 0962-9343
Elektronische ISSN: 1573-2649
DOI: https://doi.org/10.1007/s11136-014-0636-5

Springer Professional

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu Ihrer Lizenz zu erhalten.

Sie haben noch keine Lizenz? Dann Informieren Sie sich jetzt über unsere Produkte:

Springer Professional "Wirtschaft+Technik"

Springer Professional "Wirtschaft"

Weitere Artikel der Ausgabe 6/2014

Erratum to: Development and validation of the functional assessment of chronic illness therapy treatment satisfaction (FACIT TS) measures

Development and psychometric properties of the Maastricht Personal Autonomy Questionnaire (MPAQ) in older adults with a chronic physical illness

Impact of autism in adolescents on parental quality of life

Understanding the relative importance of preserving functional abilities in Alzheimer’s disease in the United States and Germany

Health-related quality of life of children and adolescents with functional disabilities in a northern Swedish county

Assessing spiritual well-being in residents of nursing homes for older people using the FACIT-Sp-12: a cognitive interviewing study