Depression and Effect of Mortality in Hospitalized Patients with Decompensated Heart Failure

Abstract

Introduction: Hearth failure frequently seems with depression and increases the morbidity and mortality with worse prognosis. In this study, we aimed to investigate the psychological situation of decompensated syctolic heart failure (DSHF) patients and applied medical and psychological therapy to them. Materials and Methods: Totally 71 patients enrolled to the study which entered to Cardiology Department of Abant Izzet Baysal University Medical School Hospital with diagnosis of functional class II-IV DSHF according to New York Cardiology Association classification and ejection fraction (EF) of 40% or lower. These patients were divided into two groups (Group A: NHYA grade 2-3, Group B NYHA grade 4). The depression of patients were evaluated by geriatric depression scale (GDS). Results: Twenty one (29.6%) of 71 patients had depression consisting of 8 (38%) male and 13 (62%) female. The depression in female patients were significantly different from male patients (p< 0.05). GDS scores were significantly higher in group B patients (p< 0.05). There was a positive corelation between GDS scores and age (r= 0.648, p= 0.023) and female patients have had significantly higher GDS scores (p< 0.05). The adaptation to the treatment was significantly better in non-depressive patients (p< 0.05). There was a positive corelation between the hospital entrance number due to NC-SHF and GDS scores in all DSHF (r= 0.415, p< 0.05). On the other hand, there was a negative corelation between the EF and GDS scores (r= -0.307, p= 0.019). Conclusion: Depression is frequently seen in patients with DSHF. These patients should be carefully followed against psychiatric symptoms to give adequate treatment.

Keywords

• Depression; heart failure; prognosis; mortality.

Kardiyoloji Servisinde Yatan Dekompanse Sistolik Kalp Yetmezlikli Hastalarda Depresyon Sıklığı ve Prognoza Etkisi

Abstract

Giriş: Kalp yetmezliği ile depresyon birlikteliği sık görülmekte olup, morbidite ve mortaliteyi artırıp, prognozu kötüleştirmektedir. Biz bu çalışmamızda dekompanse sistolik kalp yetmezliği (DSKY) tanısıyla hastanede takip edilen hastaların psikolojik durumlarını değerlendirerek bu konuda hastaya verilen medikal ve terapi desteğini saptamaya çalıştık. Materyal ve Metod: Çalışmamıza Abant İzzet Baysal Üniversitesi Tıp Fakültesi Kardiyoloji Kliniğinde New York Kalp Birliği sınıflandırma sistemi (NHYA) ile fonksiyonel sınıf II-IV DSKY tanısı ile yatırılan ve ejeksiyon fraksiyonu (EF) %40 ve altında olan toplam 71 hasta dahil edildi. Bu hastalar NHYA sistemine göre iki gruba ayrıldı (Grup A: Evre 2-3, Grup B: Evre 4). Hastaların depresyon durumları geriyatrik depresyon ölçeği (GDÖ) ile değerlendirildi. Bulgular: Yetmiş bir hastanın 21 (%29.6)'inin depresyonda olduğu görüldü. Bu hastaların 8 (%38)'i erkek, 13 (%62)'ü ise kadındı. Kadın hastalarda daha fazla sayıda depresyon saptandı (p< 0.05). GDÖ skorları Grup B'deki hastalarda daha yüksekti (p< 0.05). GDÖ skorları ile yaş arasında pozitif korelasyon vardı (r= 0.648, p= 0.023) ve kadın hastalar daha yüksek GDÖ skoruna sahiplerdi. (p< 0.05). Depresyon olmayan hastalarda, tedaviye uyum daha iyiydi (p< 0.05). Tüm DSKY hastalarında DSKY nedeniyle hastaneye yatış sayısı ile GDÖ skorları arasında pozitif korelasyon saptandı (r= 0.415, p< 0.05). Tüm DSKY hastalarında EF ile GDÖ skorları arasında negatif korelasyon saptandı (r= -0.307, p= 0.019). Sonuç: DSKY nedeniyle hastaneye yatırılan hastaların büyük kısmında depresyon görülebilmektedir. Bu hastalarda psikiyatrik semptomlara dikkat edilmeli ve gerektiğinde uygun tedavi başlanmalıdır.

Keywords

• Depresyon; kalp yetmezliği; prognoz; mortalite.

References

1. Narula J, Arbustini E, Chandiashektar Y, Scwaiger M. Apoptosis and the systolic dysfunction in congestive heart failure. Cardiology Clinics 2001;19:113-26.
2. O’Connel JB, Bristow MR. Economic impact of heart failure in the United States. Time for a different approach. J Heart Lune Trans- plant 1994;13:5107-12.
3. Yılmaz E, Eser E, Gürgün C, Kültürsay H. Kronik kalp yetersizliği anketinin (KKYA) Türkçe sürümünün geçerlilik ve güvenirlik ça- lışması. Anadolu Kardiyol Derg 2010;10:000-000 (doi:10.5152/ akd.2010.162).
4. Franzen K, Blomqvist K, Saveman B. Impact of chronic heart fai- lure on elderly persons’ daily life: a validation study. Eur J Cardio- vasc Nurs 2006;5:137-45.
5. Karpolat H, Durmaz B, Nalbantgil S, Durmaz. Kalp yetersizliginde yaşam kalitesi ve fonksiyonel durum. Anadolu Kardiyoloji Dergisi 2006;6:327-32.
6. Havranek EP, Ware MG, Lowes BD. Prevalence of depression in congestive heart failure. Am J Cardiol 1999;84:348-50.
7. Freedland KE, Rich MW, Skala JA, Carney RM, Davila-Roman VG, Jaffe AS. Prevalence of depression in hospitalized patients with congestive heart failure. Psychosom Med 2003;65:119-28.
8. Lesman-Leegte I, Jaarsma T, Sanderman R, Hillege HL, van Veldhuisen DJ. Determinants of depressive symptoms in hospi- talised men and women with heart failure. Eur J Cardiovasc Nurs 2008;7:121-6.

9. Guck TP, Elsasser GN, Kavan MG, Barone EJ. Depression and congestive heart failure. Congest Heart Fail 2003;9:163-9.
10. Norra C, Skobel EC, Arndt M, Schauerte P. High impact of depres- sion in heart failure: early diagnosis and treatment options. Int J Cardiol 2008;125:220-31.
11. Faller H, Störk S, Schowalter M, et al. Depression and survival in chronic heart failure: does gender play a role? Eur J Heart Fail 2007;9:1018-23.
12. Azevedo A, Bettencourt P, Friões F, Alvelos M, Abreu-Lima C, Hense HW, Barros H. Depressive symptoms and heart failure sta- ges. Psychosomatics 2008;49:42-8.
13. Jiang W, Kuchibhatla M, Clary GL Cuffe MS, Christopher EJ, Alexander JD, et al. Relationship between depressive symptoms and long-term mortality in patients with heart failure. Am Heart J 2007;154:102-8.
14. Yesavage JA, Brink TL, Rose TL. Development and validation of geriatric depression screening scale: a preliminary report. J Psychiat Res 1983;17:37-49.
15. Ertan T, Eker E, Sar V. Reliability, validity and factor structure of the geriatric depression scale in Turkish elderly: are there diffe- rent factor structures for different cultures? Int Psychogeriatr 2000;12:163-72.
16. Bhuiyan T, Maurer MS. Heart failure with preserved ejection frac- tion: persistent diagnosis, therapeutic enigma. Curr Cardiovasc Risk Rep 2011;5:440-9. PubMed PMID: 22081782.
17. Özkan S, Bahadır G, Kırpınar İ ve ark. Genel Tıpta Depresyon. Konsültasyon-Liyezon Psikiyatrisi 1994-1995, İstanbul, Pfizer A.Ş, 1994:81-90.
18. Rouchell AM, Pounds R, Tierney JG. Depression. Textbook of Consultation-Liaison Psychiatry. In: Rundell JR, Wise MG (eds). Washington, American Psychiatric Press, 1996:310-45.
19. Azevedo A, Bettencourt P, Friões F, Alvelos M, Abreu-Lima C, Hense HW, et al. Depressive symptoms and heart failure stages. Psychosomatics 2008;49:42-8.
20. Amerikan Psikiyatri Birliği: Psikiyatride Hastalıkların Tanımlan- ması ve Sınıflandırılması Elkitabı, Yeniden Gözden Geçirilmiş 4.Baskı (DSM-4-TR), Amerikan Psikiyatri Birliği, Washington DC, 2000’den çeviren Köroğlu E, Hekimler Yayın Birliği, Ankara: 2001.
21. Harold G. Koenig, MD. Depression outcome in inpatients with con- gestive heart failure. Arch Intern Med 2006;166:991-6.
22. Szyguła-Jurkiewicz B, Duszańska A, Poloński L. Is depression a problem in patients with chronic heart failure? Pol Arch Med Wewn 2008;118:52-6.
23. Skotzko C, Krichten C, Zietowski G, Alves L, Freudenberger R, Robinson S, et al. Depression is common and precludes accurate assessment of functional status in elderly patients with congestive heart failure. J Card Fail 2000;6:300-5.
24. Koenig HG. Depression in hospitalized older patients with conges- tive heart failure. Gen Hosp Psychiatry 1998;20:29-43.
25. Carney RM, Freedland KE, Eisen SA, Rich MW, Jaffe AS. Major depression and medication adherence in elderly patients with co- ronary artery disease. Health Psychol 1995;14:88-90.
26. Çelikel FÇ, Kumbasar H. Kronik kalp yetersizliğinde depres- yon ve tedavisi. Turkiye Klinikleri J Cardiol-Special Topics 2008;1:143-9.
27. van der Wal MH, Jaarsma T, van Veldhuisen DJ. Non-compliance in patients with heart failure; how can we manage it? Eur J Heart Fail 2005;7:5-17.
28. Norra C, Skobel EC, Arndt M, Schauerte P. High impact of depres- sion in heart failure: early diagnosis and treatment options. Int J Cardiol 2008;125:220-31.
29. Swan HJC. Can heart failure be prevented, delayed or reversed? Am Heart J 1990;120:1540-6.
30. Shapiro PA, Lesperance F, Frasure-Smith N. An open-label pre- liminary trial of sertraline for treatment ofmajor depression after acute myocardial infarction (the SADHAT Trial). Sertraline Anti- Depressant Heart Attack Trial. Am Heart J 1999;137:1100-6.
31. The Task Force of the Working Group on Heart Failure of the Eu- ropean Society of Cardiology Guideline for the diagnosis and tre- atment of chronic heart failure. Eur Heart J 2001;17:1527-60.
32. Bauer M, Whybrow PC, Angst J, Versiani M, Moller HJ. World Federation of Societies Biological Psychiatry Task Force on Tre- atment Guidelines for Unipolar Depressive Disorders. (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disor- ders, Part 1: acute and continuation treatment of major depressi- vedisorder. World J Biol Psychiatry 2002;3:5-43.