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Treating depression helps HF patientsí health

Wednesday October 31, 2012
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Controlling depression in patients with heart failure can improve health status, social functioning and quality of life, according to a study.

Although depression has been known to worsen a variety of diseases, the study is one of the first to show that reducing symptoms of the mental health condition can benefit physical health, researchers said.

"The improved endurance measurements were especially striking," Glen Xiong, MD, the studyís lead author and an associate clinical professor of psychiatry and behavioral sciences at the University of California, Davis, said in a news release. "I think clinicians will be more motivated to both screen and treat depressive symptoms in people with heart failure because of the significant functional improvements."

The estimated direct and indirect costs of heart failure in the U.S. are more than $37 billion. It affects more than 5 million Americans, about 20% of whom also are diagnosed with depression.

For the study, researchers conducted a secondary analysis on data obtained from the 2008 Sertraline Against Depression and Heart Disease in Chronic Heart Failure study. Study participants were 469 men and women ages 45 and older with both heart failure and major depressive disorder.

The researchers used data from rigorous, standardized evaluations administered over the course of the 12-week SADHART-CHF study to measure both depression and general health. The Hamilton Depression Rating Scale questionnaire was administered periodically to all study participants to assess the severity of depressive symptoms. Cardiac and general health were determined using the Kansas City Cardiomyopathy Questionnaire and the Short Form Health Survey (completed by 285 study participants) and a six-minute walk test (completed by 378 participants).

Participants whose depression remitted during the trial intervention had improvement on scores of physical health on a variety of measures, including social limitation, physical limitation, quality of life, symptom frequency and total symptoms.

"To put the results in perspective, a five-point change in the Kansas City Cardiomyopathy Questionnaire is clinically significant," Xiong said. "The patients whose depression was in remission had scores 13 points higher than those who were not in remission."

Those outcomes were backed up by the Short Form Health Survey, which showed that reduced depression symptoms also improved physical function and general health perception. Data from the six-minute walk test also showed significant improvements in endurance, with patients with reduced depression able to walk an average of about 154 feet more than their counterparts with major depression.

According to the researchers, their results open up a new avenue of investigation that could lead to therapies that leverage the connections between the mind and the body and help heart-failure patients stabilize their condition.

"Researchers and practitioners increasingly recognize that the mind and the body have powerful connections, which is promising since they have been segregated for years," said Wei Jiang, senior author of the study and director of the Neuropsychocardiology Laboratory at Duke University Medical Center in Durham, N.C.

"This kind of interdisciplinary research can help find answers to how physical health affects mental health, and vice versa, and inform the development of clinical practices that recognize this approach."

The study is scheduled for publication in the Nov. 20 issue of Circulation: Heart Failure. The study abstract is available at http://circheartfailure.ahajournals.org/content/early/2012/10/12/CIRCHEARTFAILURE.112.967620.abstract.


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