Elsevier

Journal of Cardiac Failure

Volume 13, Issue 10, December 2007, Pages 818-824
Journal of Cardiac Failure

Clinical Investigation
Depression Is a Major Determinant of Quality of Life in Patients With Chronic Systolic Heart Failure in General Practice

https://doi.org/10.1016/j.cardfail.2007.07.008Get rights and content

Abstract

Background

Quality of life (QoL) is severely restricted in patients with chronic heart failure (CHF). Patients frequently suffer from depressive comorbidity. It is not clear, to what extent sociodemographic variables, heart failure severity, somatic comorbidities and depression determine QoL of patients with CHF in primary care.

Methods and Results

In a cross-sectional analysis, 167 patients, 68.2 ± 10.1 years old, 68.9% male, New York Heart Association (NYHA) functional class II-IV, Left ventricular ejection fraction (LVEF) ≤40%, were recruited in their general practitioner's practices. Heart failure severity was assessed with echocardiography and N-terminal brain natriuretic peptide (NT-proBNP); multimorbidity was assessed with the Cumulative Illness Rating Scale (CIRS-G). QoL was measured with the Short Form 36 Health Survey (SF-36) and depression with the depression module of the Patient Health Questionnaire (PHQ-9). Significant correlations with all SF-36 subscales were only found for the CIRS-G (r = −0.18 to −0.36; P < .05) and the PHQ-9 (r = −0.26 to −0.75; P < .01). In multivariate forward regression analyses, the PHQ-9 summary score explained the most part of QoL variance in all of the SF-36 subscales (r2 = 0.17–0.56). LVEF and NT-proBNP did not have significant influence on QoL.

Conclusions

Depression is a major determinant of quality of life in patients with chronic systolic heart failure, whereas somatic measures of heart failure severity such as NT-proBNP and LVEF do not contribute to quality of life. Correct diagnosis and treatment of depressive comorbidity in heart failure patients is essential.

Section snippets

Methods

The study was conducted as a cross-sectional analysis of baseline data as part of the “train the trainer” study. The train the trainer study is a cluster-randomized intervention study with the aim of improving the QoL of patients with chronic systolic heart failure by implementing an interdisciplinary didactic training course for general practitioners (GPs) treating these patients. It was part of the Competence Network of Heart Failure (www.knhi.de), a research association funded by the German

Patient Characteristics

A total of 167 patients fulfilled inclusion criteria and participated in the study. Their characteristics are summarized in Table 1. The population was predominantly male with an age range of 44 to 90 years (mean 68.2 years). Most of the patients were living with a partner, and 61.1% were married. Patients predominantly had a nonacademic education background; >95% of patients were in retirement; every 5th patient had a monthly income <1000 €.

Most patients were in NYHA functional class II or III

Discussion

QoL is severely limited in patients with CHF. In a cross-sectional study, we analyzed the impact of sociodemographic variables, objective measures of heart failure severity, somatic comorbidities, and depressive comorbidity on the variance of QoL in patients with CHF treated in primary care using linear forward regression analyses. By far the greatest impact on QoL variance was found for depression severity as assessed by the summary score of the PHQ-9. Heart failure severity only accounted for

Conclusions

Quality of life in patients with systolic heart failure in primary care is severely limited. Depressive symptomatology is the main determinant of this restriction in quality of life in cross-sectional analysis. Sociodemographic factors, comorbidity, and multimorbidity do not contribute substantially to that restriction. Somatic risk predictors of heart failure prognosis, namely LVEF and NT-proBNP, have no relevant effect on the patient's perception of health status, well-being, and quality of

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    Supported by the Competence Network of Heart Failure, funded by the German Ministry of Education and Research (BMBF), FKZ 01GI0205.

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