The Behavioral Medicine Report

Researchers* acquired data during March 1, 2003 to December 31, 2004 from the The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) to further explore the connection between depression and heart failure. Data from the medical charts of 48,612 patients (mean age = 73) from 259 hospitals were included. The authors* provide a good overview of the widely known link between depression and poorer outcomes in those with heart failure, particularly in the elderly. For example, those who enter the hospital with depression will often have decreased functioning and are more likely to return to the hospital or die within 6 months. In fact, one study found that the presence of depression better accounted for physical limitations than actual physical reasons.

In the current study, a number of important findings were reported on the relationship between depression and heart problems in the elderly. Here is an overview of key statistically significant findings:

• Overall, 10.6% of participants had history of depression
• Depression was more common in females and whites
• Depression occurred significantly more often when common co-morbid conditions of cardiac failure were present, such as chronic pulmonary obstructive disease (COPD), anemia, Type 1 Diabetes (insulin-dependent diabetes mellitus), and hyperlipidemia.
• Patients with a history of depression received fewer treatments, such as coronary interventions, heart devices, or referral to outpatient disease management programs, and were less likely to receive core heart failure education instructions at discharge
• A history of depression also resulted longer hospital stays and higher post-discharge mortality rates.
• Depression predicted the length of hospital stay and post-discharge death

As has been shown time and time again and within the current study, the important role that mental health plays in physical health cannot be ignored. Obviously, persons with poor physical health, including heart failure, should be routinely screened for the presence of anxiety and depression and referred for appropriate treatment. In fact, this is one of the reasons why clinical health psychology and behavioral medicine exist. I found it disturbing that those with a history of depression received less care, and I think that this needs to be investigated further. My hope is that the current study will help physicians provide an even higher standard of care for their patients with cardiac-related diseases.

CFisher

Reference:
*Albert, N., Fonarow, G., Abraham, W., Gheorghiade, M., Greenberg, B., Nunez, E., O’Connor, C., Stough, W., Yancy, C., & Young, J. (2009). Depression and clinical outcomes in heart failure: An OPTIMIZE-HF analysis. The American Journal of Medicine, 122, 366-373.

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