Relation of Depression to Severity of Illness in Heart Failure (from Heart Failure And a Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION])

      Depression is common in patients with heart failure (HF), prognostic for adverse outcomes and purportedly related to disease severity. Psychological and physiologic factors relevant to HF were assessed in HF-ACTION, a large randomized study of aerobic exercise training in patients with systolic HF. The relation of objective and subjective parameters was compared with scores on the Beck Depression Inventory (BDI) to examine the hypothesis that depressive symptoms are better associated with perception of disease severity than with objective markers of HF severity. At baseline, 2,322 of 2,331 subjects entered into HF-ACTION completed questionnaires to assess depression (BDI) and quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]). Objective markers of HF severity included ejection fraction, B-type natriuretic peptide, and peak oxygen consumption (using cardiopulmonary exercise testing, with evaluation of duration and respiratory exchange ratio also performed). Measures more likely to be affected by perceived functional status included New York Heart Association (NYHA) classification and the 6-minute walk test. Objective assessments of disease severity were slightly related (peak oxygen consumption) or not related (B-type natriuretic peptide and ejection fraction) to BDI scores. Using multivariate analysis (KCCQ not included), only age, gender, cardiopulmonary exercise testing duration, NYHA class, 6-minute walk distance, and peak respiratory exchange ratio independently correlated with BDI scores. In conclusion, depression was minimally related to objective assessments of severity of disease in patients with HF, but was associated with patient (and clinician) perceptions of disease severity. Addressing depression might improve symptoms in patients with HF.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Davidson K.W.
        • Kupfer D.J.
        • Bigger J.T.
        • Califf R.M.
        • Carney R.M.
        • Coyne J.C.
        • Czajkowski S.M.
        • Frank E.
        • Frasure-Smith N.
        • Freedland K.E.
        • Froelicher E.S.
        • Glassman A.H.
        • et al.
        Assessment and treatment of depression in patients with cardiovascular disease: National Heart, Lung, and Blood Institute Working Group Report.
        Psychosom Med. 2006; 68: 645-650
        • Ferketich A.K.
        • Binkley P.F.
        Psychological distress and cardiovascular disease: results from the 2002 National Health Interview Survey.
        Eur Heart J. 2005; 26: 1923-1929
        • Whellan D.J.
        • O'Connor C.M.
        • Lee K.L.
        • Keteyian S.J.
        • Cooper L.S.
        • Ellis S.J.
        • Leifer E.S.
        • Kraus W.E.
        • Kitzman D.W.
        • Blumenthal J.A.
        • et al.
        • HF-ACTION Trial Investigators
        Heart failure and a controlled trial investigating outcomes of exercise training (HF-ACTION): design and rationale.
        Am Heart J. 2007; 153: 201-211
        • Beck A.T.
        • Ward C.H.
        • Mendelsohn M.
        • Mock J.
        • Erbaugh J.
        An inventory for measuring depression.
        Arch Gen Psych. 1961; 4: 561-571
        • Green C.P.
        • Porter C.B.
        • Bresnahan D.R.
        • Spertus J.A.
        Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure.
        J Am Coll Cardiol. 2000; 35: 1245-1255
        • Gottlieb S.S.
        • Khatta M.
        • Friedmann E.
        • Einbinder L.
        • Katzen S.
        • Baker B.
        • Marshall J.
        • Minshall S.
        • Robinson S.
        • Fisher M.L.
        • et al.
        The influence of age, gender, and race on the prevalence of depression in heart failure patients.
        J Am Coll Cardiol. 2004; 43: 1542-1549
        • Haveranek E.P.
        • Ware M.G.
        • Lowes B.P.
        Prevalence of depression in congestive heart failure.
        Am J Cardiol. 1999; 84: 348-350
        • Jiang W.
        • Kuchibhatla M.
        • Cuffe M.S.
        • Christopher E.J.
        • Alexander J.D.
        • Clary G.L.
        • Blazing M.A.
        • Gaulden L.H.
        • Califf R.M.
        • Krishnan R.R.
        • O'Connor C.M.
        Prognostic value of anxiety and depression in patients with chronic heart failure.
        Circulation. 2004; 110: 3452-3456
        • MacMahon K.M.A.
        • Lip G.Y.H.
        Psychological factors in heart failure: a review of the literature.
        Arch Intern Med. 2002; 162: 509-516
        • Gottlieb S.S.
        • Kop W.J.
        • Thomas S.A.
        • Katzen S.
        • Vesely M.R.
        • Greenberg N.
        • Marshall J.
        • Cines M.
        • Minshall S.
        A double-blind placebo-controlled pilot study of controlled-release paroxetine on depression and quality of life in chronic heart failure.
        Am Heart J. 2007; 153: 868-873
        • Skotzko C.E.
        • Krichten C.
        • Zietowski G.
        • Alves L.
        • Freudenberger R.
        • Robinson S.
        • Fisher M.
        • Gottlieb S.S.
        Depression is common and precludes accurate assessment of functional status in elderly patients with congestive heart failure.
        J Card Fail. 2000; 6: 300-305
        • Müller-Tasch T.
        • Peters-Klimm F.
        • Schellberg D.
        • Holzapfel N.
        • Barth A.
        • Jünger J.
        • Szecsenyi J.
        • Herzog W.
        Depression is a major determinant of quality of life in patients with chronic systolic heart failure in general practice.
        J Card Fail. 2007; 13: 818-824
        • Ruo B.
        • Rumsfeld J.S.
        • Hlatky M.A.
        • Liu H.
        • Browner W.S.
        • Whooley M.A.
        Depressive symptoms and health-related quality of life: the Heart and Soul Study.
        JAMA. 2003; 290: 215-221
        • Norra C.
        • Skobel E.C.
        • Arndt M.
        • Schauerte P.
        High impact of depression in heart failure: early diagnosis and treatment options.
        Int J Cardiol. 2008; 125: 220-231
        • Bekelman D.B.
        • Havranek E.P.
        • Becker D.M.
        • Kutner J.S.
        • Peterson P.N.
        • Wittstein I.S.
        • Gottlieb S.H.
        • Yamashita T.E.
        • Fairclough D.L.
        • Dy S.M.
        Symptoms, depression, and quality of life in patients with heart failure.
        J Card Fail. 2007; 13: 643-648
        • Rector T.
        • Anand I.
        • Cohn J.
        Relationships between clinical assessments and patients' perceptions of the effects of heart failure on their quality of life.
        J Card Fail. 2006; 12: 87-92
        • Beck A.T.
        • Stear R.A.
        • Garben M.G.
        Psychometric Properties of the Beck Depression Inventory: Twenty-Five Years of Evaluation.
        2nd ed. Houghton Mifflin, Boston, MA1985