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Diabetes, depression predict poor survival, rehospitalization in patients with heart failure
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Poorer survival and rehospitalization in patients with heart failure are associated with comorbid diabetes and depressive symptoms, according to recent study findings published in BMJ Open Diabetes Research & Care.
Effective strategies are needed for regularly evaluating and managing comorbid conditions to improve survival and reduce hospitalization rates, researchers wrote.
Abdullah S. Alhurani, PhD, MSN, RN, of the University of Kentucky and the University of Jordan, and colleagues evaluated data from the HF Health-Related Quality of Life Collaborative Registry on 663 adults (mean age, 61 years; 69% men) to determine the association of comorbid heart failure, diabetes and depression with all-cause mortality and cardiac rehospitalization. Follow-up was conducted for at least 2 years.
Participants were divided into the following four groups: no diabetes and no depressive symptoms (n = 265), depressive symptoms only (n = 131), diabetes only (n = 177) and both diabetes and depressive symptoms (n = 90).
Seven percent of participants died during follow-up. The presence of both diabetes and depression (P = .005), presence of depression alone (P = .05), white ethnicity (P = .02), New York Heart Association functional class (P = .01) and prescriptions for antidepressant medications (P < .001) were all independent predictors of increased mortality. Absence of a coronary artery disease diagnosis (P = .001), increased BMI (P = .02) and greater left ventricle ejection fraction (P = .002) were all predictors of reduced mortality. A significant predictor of mortality was depressive symptoms (HR = 1.12; 95% CI, 1.06-1.18), whereas diabetes was not (HR = 0.93; 95% CI, 0.54-1.75).
There were 115 cardiac hospitalizations during follow-up. Compared with participants without diabetes or depression, participants with diabetes and depression were 2.4 times more likely to be rehospitalized. There was a 1.7 times greater likelihood of rehospitalization for participants prescribed antidepressant medications compared with those who did not have prescriptions. A significant predictor of rehospitalization was depressive symptoms (HR = 1.06; 95% CI, 1.03-1.1), whereas diabetes was not (HR = 1.28; 95% CI, 0.89-1.86).
“The combination of comorbid diabetes and depressive symptoms was associated with a 3.7 times and 2.4 times greater likelihood of mortality and cardiac rehospitalization, respectively,” the researchers wrote. “Thus, the presence of diabetes, heart failure and depressive symptoms demonstrated an apparent cumulative effect on mortality and cardiac rehospitalization.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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