Living with heart failure: depression and quality of life in patients and spouses

doi:10.1016/S1053-2498(02)00818-5

The Journal of Heart and Lung Transplantation

Volume 22, Issue 4, April 2003, Pages 460-467

https://doi.org/10.1016/S1053-2498(02)00818-5 Get rights and content

Abstract

Background:

Although spouses are a key support for patients with heart failure, and help them remain in the community, no one has studied patient–spouse pairs to determine the nature of their experience. Therefore, we conducted a study of patients and spouses to compare their levels of depression and health-related quality of life (HRQOL), and to identify factors that contribute to depression and HRQOL in patient–spouse pairs.

Methods:

Forty-eight couples, in which all patients were men with heart failure, were recruited from a university-affiliated, outpatient heart failure clinic. Data were collected using the Beck Depression Inventory, the 12-item Short Form (that measures physical and mental components of QOL), and the 6-minute walk test.

Results:

Patients with heart failure were significantly more depressed and had poorer physical quality of life compared with spouses. Patients’ depression was correlated with their own functional status and mental quality of life, with the combination of 6-minute walk distance and mental QOL contributing 51% of the variance in patient depression. Spouse depression and HRQOL did not significantly influence patient depression. In contrast, spouses’ depression was related to their husbands’ functional status and employment, as well as their own mental QOL. The mental component of spouse QOL and the age of the patient accounted for 33% of the adjusted variance in spousal depression.

Conclusions:

Patients with heart failure and their spouses experience significantly different levels of depression and physical QOL. In developing interventions, it may be important to take these differences into account and focus on their unique needs as well as those issues that affect the couple together. Interventions that improve patient functional status may result in decreased depression and improved HRQOL on the part of both patients and spouses.

Section snippets

Design and sample

This study utilized a 2-group, comparative design. Appropriate institutional review board approval for the study was received from the participating center and permission to contact eligible patients who volunteered was obtained from the patients’ cardiologists. Patients were being seen at a university-affiliated, outpatient heart failure clinic on the west coast of the USA, which is also affiliated with an active cardiac transplant program. The recruitment period was from January 1999 to

Results

Forty-eight couples participated in the study. Although the study criteria included both men and women, only 4 of the 52 couples included had female patients. Due to the small numbers of female patients, and to provide a more homogeneous sample, female patients were excluded. The majority of patients were white (77%) and unemployed (81%). The high number of unemployed reflect the relatively advanced stage of heart failure in this sample of patients. Thirty-one of the 48 (65%) were NYHA Class

Discussion

This study demonstrates that patients with heart failure and their spouses are significantly different in their experience of depressive symptoms and in the physical component of QOL, with patients experiencing significantly more depression and worse physical QOL than spouses. Interestingly, neither patients nor spouses reported significant differences in the mental component of their QOL, a scale that reflects vitality, social functioning, role limitations due to emotional problems and mental

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Depression Subtypes in Systolic Heart Failure: A Secondary Analysis From a Randomized Controlled Trial
2023, Journal of the Academy of Consultation-Liaison Psychiatry
Heart failure (HF) is associated with an elevated risk of morbidity, mortality, hospitalization, and impaired quality of life. One potential contributor to these poor outcomes is depression. Yet the effectiveness of treatments for depression in patients with HF is mixed, perhaps due to the heterogeneity of depression.
This secondary analysis applied latent class analysis (LCA) to data from a clinical trial to classify patients with systolic HF and comorbid depression into LCA subtypes based on depression symptom severity, and then examined whether these subtypes predicted treatment response and mental and physical health outcomes at 12 months follow-up.
In LCA of 629 participants (mean age 63.6 ± 12.9; 43% females), we identified 4 depression subtypes: mild (prevalence 53%), moderate (30%), moderately severe (12%), and severe (5%). The mild subtype was characterized primarily by somatic symptoms of depression (e.g., energy loss, sleep disturbance, poor appetite), while the remaining LCA subtypes additionally included nonsomatic symptoms of depression (e.g., depressed mood, anhedonia, worthlessness). At 12 months, LCA subtypes with more severe depressive symptoms reported significantly greater improvements in mental quality of life and depressive symptoms compared to the LCA mild subtype, but the incidence of cardiovascular- and noncardiovascular-related readmissions, and mortality was similar among all subtypes.
In patients with depression and systolic heart failure those with the LCA mild depression subtype may not meet full criteria for major depressive disorder, given the overlap between HF and somatic symptoms of depression. We recommend requiring depressed mood or anhedonia as a necessary symptom for major depressive disorder in patients with HF.
Psychological Disorders in Heart Failure
2022, Cardiology Clinics
Citation Excerpt :
The 9-item Patient Health Questionnaire (PHQ-9) can be used to both diagnose depression and grade severity (Table 1). Depression in patients with HF is significantly related to reduced functional status,10,15 greater symptom severity,16 and poorer health-related quality of life17–19 and contributes to nonadherence9,16 and participation in high-risk behaviors such as smoking and alcohol use.20,21 Additionally, it drives higher use across the care continuum, including emergency department visits, hospitalizations, readmissions, and outpatient office visits.22–24
Psychological Disorders in Heart Failure
2020, Heart Failure Clinics
Influence of preparedness on anxiety, depression, and quality of life in caregivers of heart failure patients: Testing a model of path analysis
2019, Patient Education and Counseling
Citation Excerpt :
More difficult to explain is the finding that a higher physical QOL in caregivers was associated with a higher NYHA class in patients. Mårtensson et al. [14] found the opposite result, but related to the mental component of QOL associated with the NYHA class; another study [13] showed that NYHA class is directly related to depression. However, in the literature, similar results are scarce.
Testing the influence of heart failure (HF) caregiver preparedness on anxiety and depression, and the influence of HF caregiver anxiety and depression on caregiver physical and mental QOL.
In this cross-sectional study, we used the Caregiver Preparedness Scale (CPS), the Hospital Anxiety and Depression Scale (HADS) with the anxiety (HADS-A) and depression (HADS-D) subscales, and the Short-Form 12 (SF-12) measuring the physical component summary (PCS) and the mental component summary (MCS) of QOL. Socio-demographic data and patients’ clinic data were also collected. Data analysis was conducted with descriptive statistics, correlations, and path analysis.
A total of 366 HF caregiver and patient dyads were enrolled. Caregivers were mostly females (73.3%) with a mean age of 58.61 (SD = 15.66) years. The tested model showed excellent fit indices with the following significant paths: CPS scores predicted HADS-D scores; HADS-A scores predicted MCS scores; and HADS-D scores predicted both PCS and MCS scores. Also, HADS-D mediated the relationship between CPS and MCS scores.
Preparedness influences HF caregiver depression and depression influences caregiver physical and mental QOL. Depression mediates between preparedness and HF caregiver mental QOL.
Interventions focused on improving HF caregiver preparedness may improve caregivers’ depression and QOL.
Examining the impacts of 12 weeks of low to moderate-intensity aerobic exercise on depression status in patients with systolic congestive heart failure-a randomized controlled study
2019, Clinics
Psychiatric depression disorder is common in patients with systolic congestive heart failure (HF), and both conditions share underlying pathophysiological mechanisms. The incidence rate of depression disorder has clearly increased with the increase in HF manifestations in recent decades. Depression disorder is considered an independent predisposing factor for hospitalization, disturbed functional performance, and high rates of morbidity and mortality in HF patients. This randomized controlled study was designed to examine the impacts of low- to moderate-intensity aerobic exercise training on depression status in patients with systolic congestive HF.
A total of 46 systolic congestive HF patients with depression (40-60 years of age) were randomized to receive twelve weeks of mild- to moderate-intensity aerobic exercise plus standard medical treatment (exercise group) or standard medical treatment without any exercise intervention (control group). Depression status was examined using the validated Patient Health Questionnaire-9 (PHQ9) pre- and post-intervention at the end of the study program.
No significant differences were observed between the exercise and control groups in demographic data or clinical characteristics (p>0.05). Both study groups showed a significant reduction in depression status at the end of the 12-week intervention (p<0.05). The comparison between the mean values of the depression scores showed significant differences between the two groups after 6 and 12 weeks of the intervention, indicating a greater reduction in depression scores in the exercise group than in the control group (p<0.05).
Twelve weeks of a low- to moderate-intensity aerobic exercise program was safe and effective for reducing depression severity in patients with systolic congestive HF. Low- to moderate-intensity aerobic training should be recommended for cardiac patients, particularly those with HF-related depression.
Comparison of treatment options for depression in heart failure: A network meta-analysis
2019, Journal of Psychiatric Research
Depression independently predicts poor outcomes in heart failure (HF) patients, including increased mortality, morbidity and 30-day re-hospitalization. In this network meta-analysis, we compared different interventions designed to treat depression in HF.
Electronic searches were conducted using Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and PsycINFO up to November 2016. Included randomized clinical trials (RCTs) compared interventions (Exercise therapy (ET), cognitive behavioral therapy (CBT) or antidepressant (AD) medications) for depression in heart failure patients. The primary outcome was change in depressive symptoms based on validated measures of depression. Network meta-analysis based on random effects model estimating standardized mean difference (SMD) with 95% confidence interval (CI), compared the effects of the 3 classes of interventions with respect to usual care or placebo control conditions.
A total of 21 RCTs (including 4563 HF patients) reporting the effects of treating depression in HF patients were included in the analysis. In comparison to placebo or usual standard of care, ET (SMD -0.38; 95% CI -0.54 to −0.22) and CBT (SMD -0.29; 95% CI -0.58 to −0.01) were associated with reduction in depressive symptoms whereas AD (SMD -0.16; 95% CI -0.44 to 0.11) was less effective.
This meta-analysis is suggestive of therapeutic benefit of ET and CBT in comparison to usual standard of care in treating depression in HF patients. However, comparison among the three interventions was not conclusive. Future randomized clinical trials are warranted to compare the therapeutic effects of ET, CBT and AD in such patients.

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^☆: Supported by the Research Council of Southeastern Sweden (FORSS); The Swedish Heart and Lung Foundation, Sweden; and the American Heart Association, Western Affiliate.

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Quality of lifeLiving with heart failure: depression and quality of life in patients and spouses☆

Abstract

Background:

Methods:

Results:

Conclusions:

Section snippets

Design and sample

Results

Discussion

Crit Care Nurs Clin N Am

Am J Cardiol

J Am Coll Cardiol

Heart Lung

Am J Cardiol

Heart Lung

J Heart Lung Transplant

Clin Psychol Rev

Clin Epidemiol

Nurs Clin N Am

Soc Sci Med

Gen Hosp Psychiatry

A review of quality-of-life evaluations in patients with congestive heart failure

Pharmacoeconomics

Quality of life in patients with advanced heart failure

J Heart Lung Transplant

Quality of life
Living with heart failure: depression and quality of life in patients and spouses☆