Rehospitalization and mortality for depressed, CHF patients

Here’s the abstract to Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure, by Jiang, et al.:

BACKGROUND: Patients with congestive heart failure (CHF) may have a high prevalence of depression, which may increase the risk of adverse outcomes.

OBJECTIVE: To determine the prevalence and relationship of depression to outcomes of patients hospitalized with CHF.

METHODS: We screened patients aged 18 years or older having New York Heart Association class II or greater CHF, an ejection fraction of 35% or less, or both, admitted between March 1, 1997, and June 30, 1998, to the cardiology service of one hospital. Patients with a Beck Depression Inventory score of 10 or higher underwent a modified National Institute of Mental Health Diagnostic Interview Schedule to identify major depressive disorder. Primary care providers coordinated standard treatment for CHF and other medical and psychiatric disorders. We assessed all-cause mortality and readmission (rehospitalization) rates 3 months and 1 year after depression assessment. Logistic regression analyses were used to evaluate the independent prognostic value of depression after adjustment for clinical risk factors.

RESULTS: Of 374 patients screened, 35.3% had a Beck Depression Inventory score of 10 or higher and 13.9% had major depressive disorder. Overall mortality was 7.9% at 3 months and 16.2% at 1 year. Major depression was associated with increased mortality at 3 months (odds ratio, 2.5 vs no depression; P =.08) and at 1 year (odds ratio, 2.23; P =.04) and readmission at 3 months (odds ratio, 1.90; P =.04) and at 1 year (odds ratio, 3.07; P =.005). These increased risks were independent of age, New York Heart Association class, baseline ejection fraction, and ischemic etiology of CHF.

CONCLUSIONS: Major depression is common in patients hospitalized with CHF and is independently associated with a poor prognosis.

I’m glad they paid attention to mortality, not just rehospitalization. I didn’t read past the abstract, yet still have some comments:

  • Data are 15 years old.
  • With the exception of rehospitalization at one year, results are borderline statistically significant at best.
  • Not to take away from the clinical significance of 3-month and 1-year readmission rates, but the policy world has settled on 30-day rates as the quality indicator and for Medicare payment penalties.

These are not meant to be critiques of the paper per se, just reasons why it’s not of higher interest to me right now.


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