Depressive symptoms confer increased HFpEF hospitalization risk in absence of prevalent CHD

Depressive symptoms appear to put individuals who are free of coronary heart disease (CHD) at risk of hospitalization for heart failure with preserved ejection fraction (HFpEF) but not HF with reduced ejection fraction (HFrEF), a study has found.

The study used data from the REGARDS (Reasons for Geographic And Racial Differences in Stroke) study and included 26,268 HF‐free participants aged ≥45 years. Baseline depressive symptoms were assessed and defined as a score ≥4 on the 4‐item Center for Epidemiologic Studies Depression scale. On the other hand, incident HF hospitalizations were categorized as HFpEF (EF ≥50 percent) and HFrEF, including mid‐range EF (EF <50 percent).

In the sample, 2,725 participants had depressive symptoms and 3,879 had prevalent CHD. Participants with vs without depressive symptoms were younger and were more likely to be African American, female, unmarried, have diabetes, have higher urinary albumin to creatinine ratios and C‐reactive protein, and have lower physical health status scores. Depressive symptoms were also associated with more pack‐years of smoking, physical inactivity, and medication non‐adherence. These differences persisted after stratification by baseline CHD status.

Over a median follow-up of 9.2 years, a total of 872 incident HF hospitalizations were documented; 526 of these were among participants without CHD and 334 were among those with CHD. The age‐adjusted HF hospitalization incidence rate was higher among participants with vs without depressive symptoms (4.9 vs 3.2 per 1,000 person‐years; p<0.001). The risk of overall HF was attenuated after controlling for covariates.

When HFpEF was assessed separately, depressive symptoms contributed to an increased incidence of hospitalization (adjusted hazard ratio, 1.48, 95 percent CI, 1.00–2.18) among those without baseline CHD. Conversely, depressive symptoms showed no associated with the risk of incident HFrEF hospitalizations.

The findings underscore the importance of identifying patients with depressive symptoms in the ambulatory or inpatient setting via screening in order to intervene early and improve patients’ mental and cardiovascular health.