Clinical Investigation
The Effects of Depression on the Course of Functional Limitations in Patients With Chronic Heart Failure

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Abstract

Background

This study examined whether depressive symptoms are associated with persistent functional limitations and severity classified according to the course of functional limitations in chronic heart failure (CHF) patients after discharge.

Methods and Results

The Performance Measure for Activities of Daily Living 8 (PMADL-8) was used to measure the course of functional limitations at 1, 3, and 5 months after discharge in a cohort of 148 patients. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale at 1 month after discharge. Repeated-measures logistic regression adjusting for potential confounders demonstrated that the depression groups had different persistent functional limitations (PMADL-8 scores ≥20 at 1, 3, and 5 months after discharge [χ2 = 5.3; P < .05]). Using cluster analysis, we identified 4 distinctive courses of functional limitations, and there was a graded relationship between the severity of the course and depressive symptoms (χ2 = 26.1; P < .001).

Conclusions

In this prospective study, depression was associated with poorer functional limitations in CHF patients after discharge. The findings of this study suggest that depression may be a treatment target for improving functional limitations in CHF patients during the recovery phase.

Section snippets

Design

Data were obtained from the Preventive Effect of Exercise for Management of Daily Functioning in Patients with CHF (PTMaTCH) study, a rehabilitation cohort study of CHF patients. The study protocol was registered and officially entered in the University Hospitals Medical Information Network Clinical Trials Registry system (www.umin.ac.jp, no. UMIN000000885) before the start of the study. CHF patients who underwent an inpatient rehabilitation program were recruited for the PTMaTCH study from May

Results

At the 5-month postdischarge follow-up, 254 subjects participated in the PTMaTCH study, 3 had died, 33 were rehospitalized with acute exacerbation, 1 was hospitalized for reasons other than heart failure, 3 were excluded owing to COPD, 2 were excluded owing to severe mental illness, 48 missed the PMADL-8 items at any of the 3 time points, and 16 were lost to follow-up for other reasons. Of the 254 participants, 148 successfully responded at all 3 time points (1, 3, and 5 months), and these data

Discussion

The present results indicate that depressive symptoms affect severe functional limitations in CHF patients during the recovery phase after hospital discharge. In this prospective study, the presence of depressive symptoms was an independent predictor of persistent functional limitations over a 5-month period after discharge. In contrast to most existing cross-sectional studies,31, 37, 38 our prospective study examined the recovery phase after hospital discharge. Cluster analysis revealed a

Conclusions

This study indicates that depressive symptoms are prospectively associated with severe functional limitations in CHF patients after discharge after controlling for relevant demographic and physiologic factors and physical function. Identifying clusters confirms that depressive symptoms predict the persistence of severe functional limitations and highlights their importance in the management of these patients, particularly regarding poor physical function in older patients. Further research is

Disclosures

None.

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  • Cited by (0)

    Funding: This research was part of the Preventive Effect of Exercise for Management of Daily Functioning in Patients with CHF (PTMaTCH) study and supported by a Grant-in-Aid for Scientific Research (B) from the Japan Society for the Promotion of Science (no. 19300190).

    See page 508 for disclosure information.

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