Depression and Clinical Outcomes in Heart Failure: An OPTIMIZE-HF Analysis
Abstract
Background
Depression is a risk factor of excessive morbidity and mortality in heart failure. We examined in-hospital treatment and postdischarge outcomes in hospitalized heart failure patients with a documented history of depression from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure.
Methods
We identified patient factors associated with depression history and evaluated the association of depression with hospital treatments and mortality, and early postdischarge mortality, emergency care, and rehospitalization.
Results
In 48,612 patients from 259 hospitals, depression history was present in 10.6% and occurred more often in females, whites, and those with common heart failure comorbidities, including chronic pulmonary obstructive disease (36% vs 27%), anemia (27% vs 16.5%), insulin-dependent diabetes mellitus (20% vs 16%), and hyperlipidemia (38% vs 31%), all P <.001. Patients with depression history were less likely to receive coronary interventions and cardiac devices, all P <.01; or be referred to outpatient disease management programs, P <.001. Length of hospital stay was longer with depression history (7.0 vs 6.4 days, P <.001). In 5791 patients followed-up at 60-90 days postdischarge, those with depression history had higher mortality (8.8% vs 6.4%; P=.025). After multivariable modeling, depression history remained a predictor of length of hospital stay, P <.001 and postdischarge mortality, P=.02.
Conclusions
Depression history at heart failure hospitalization may be a predictor of prolonged length of hospital stay, less use of cardiac procedures and postdischarge disease management, and increased 60-90 day mortality. Patients with depression might represent a vulnerable group in which improved use of evidence-based treatment should be considered.
jHeart and Vascular Institute, Heart Failure and Transplantation Section, Cleveland Clinic, Cleveland, Ohio
Requests for reprints should be addressed to Nancy M. Albert, PhD, RN, Nursing Institute and Kaufman Center of Heart Failure, Cleveland Clinic, 9500 Euclid Avenue, Mail code J3-4, Cleveland, OH 44195
Funding: See last page of article.
Conflict of Interest: See last page of article.
Authorship: See last page of article.
Funding: GlaxoSmithKline (GSK) funded both the OPTIMIZE-HF registry and this analysis of registry data. The OPTIMIZE-HF registry was established by GSK under the guidance of a steering committee of academic advisors, each of whom is an author on this manuscript. These academic advisors were intimately involved in the initial preparation, design, and data collection for this registry. GSK provided financial and material support for the OPTIMIZE-HF registry. Outcome, Inc. (Cambridge, Mass) created the web-based data collection tool for OPTIMIZE-HF, performed data checks, and stored site-specific and aggregate data.
Conflict of Interest: Nancy M. Albert, PhD, RN, reported that she is a consultant for Medtronic and GSK. She is on the speaker's bureau for GSK and Scios, Inc.
Gregg C. Fonarow, MD, reported that he has received research grants from GSK, Medtronic, Pfizer, and the NHLBI. He has received honoraria from Medtronic and GSK. He is a consultant for GSK, Medtronic, and Scios.
William T. Abraham, MD, reported that he has received a research grant from Amgen, Biotronik, CHF Solutions, GSK, HFA, NIH, Medtronic, Myogen, Orqis Medical, Otsuka Maryland Research Institute, Paracor Inc., and Scios, Inc. He is a consultant/on the speakers bureau for Amgen, AstraZeneca, Boehringer-Ingelheim, CHF Solutions, GSK, Guidant, Medtronic, Merck, Pfizer, ResMed, Respironics, Scios, Inc., and St. Jude Medical. He is on the Advisory Board of CardioKinetix, Inc., CHF Solutions, Department of Veterans Affairs Cooperative Studies Program, NIH, and Savacor, Inc. He has received honoraria from AstraZeneca, Boehringer-Ingelheim, GSK, Guidant, Medtronic, Merck, Pfizer, ResMed, Respironics, Scios, Inc., and St. Jude Medical.
Mihai Gheorghiade, MD, reported that he is a consultant and has received honoraria from Otsuka, Protein Design Lab, Sigma Tau, Medtronic, Pfizer, and GSK.
Barry H. Greenberg, MD, reported that he is on the speaker's bureau for GSK, AstraZeneca, Pfizer, Merck, and Novartis. He is a consultant for GSK, Osuka and Sanofi Aventis.
Eduardo Nunez, MD, reported that he is an employee (cardiovascular epidemiologist) at GSK.
Christopher M. O'Connor, MD, reported that he is a consultant for Amgen, GSK, Guidant, Medtronic, Merck, Novartis, Otsuka, Pfizer, and Scios, Inc.
Wendy G. Stough, PharmD, reported that she has received a research grant, is a consultant, and is on the speaker's bureau for GSK.
Clyde W. Yancy, MD, reported that he has received research grants from GSK, Scios, Inc., Medtronic, and NitroMed. He also is a consultant for Scios, Inc., GSK, Medtronic, NitroMed, and CHF Solutions.
James B. Young, MD, reported that he has received research grants from and is a consultant for AstraZeneca and GSK.
Authorship: With respect to this study using registry data and the resulting manuscript, the OPTIMIZE-HF steering committee had access to all study data and takes full responsibility for the accuracy of the analyses. The authors had complete control and authority over the design, data analysis, interpretation, manuscript preparation, and the decision to submit this manuscript to The American Journal of Medicine for publication. The manuscript was submitted to GSK before submission for publication. All authors meet criteria for authorship and have seen and approved the final version of this manuscript.
ABSTRACT
