Predictors of Absence of Depression in Hospitalized Patients with Heart Failure and Reduced Ejection Fraction

OBJECTIVE
Mental health is directly related to mortality in heart failure (HF) patients. Nevertheless, depression is often underdiagnosed and undertreated in HF patients. We aimed to determine the parameters associated with the absence of depression in hospitalized HF patients.

METHOD
A total of 143 hospitalized HF patients with reduced ejection fraction were included in this study. The Patient Health Questionnaire-9 (PHQ-9) scale was used for screening depression symptoms. HF patients who scored < 5, defined as patients without depression, were compared with HF patients who scored ≥ 5.

RESULTS
Depression was absent in 65 (45.5%) of the 143 hospitalized HF patients. Diabetes mellitus (P = 0.006) and beta-blocker usage (P = 0.011) were less frequent; New York Heart Association (NYHA) class (P = 0.003) and B-type natriuretic peptide (BNP) levels (P = 0.006) were lower; and estimated glomerular filtration rate (eGFR) levels (P = 0.038) were higher in HF patient without depression in our study. In multivariate analysis, NYHA class [P = 0.003, odds ratio (OR) (95% confidence interval [CI]) 0.426 (0.242-0.751)] and beta-blocker usage [P = 0.045, OR (95% CI) 0.288 (0.085-0.972)] were independently correlated with the absence of depression in hospitalized HF patients. Correlation analysis revealed a significant positive correlation between NYHA class and PHQ-9 score (r = 0.258, P = 0.002).

CONCLUSION
In our study, 45.5% of the hospitalized HF patients had no depression. Diabetes mellitus and beta-blocker usage were less frequent, NYHA class and BNP levels were lower, and eGFR levels were higher in HF patients without depression. Additionally, NYHA class and beta-blocker usage were independent predictors of the absence of depression in hospitalized HF patients. This study highlights the need for physicians to recognize the strong interaction between depression and HF and to incorporate regular depression screening into clinical practice.