Black heart failure patients endangered further by depression

22 Apr

Depression is a debilitating condition on its own, but a new study suggests that for African-American heart failure patients, even moderate symptoms could increase the risk of hospitalization or death.

Patient in hospital bed speaking to doctor and partner.
The researchers found that even moderate depressive symptoms could increase the risk of hospitalization or death for African-American heart failure patients.

The study was published in the American Heart Association (AHA) journal Circulation: Heart Failure. For their investigation, the authors compared the health outcomes of 747 African-American heart failure patients with those of 1,420 white heart failure patients.

“Identifying and treating even modest symptoms of depression in black patients with heart failure could help to improve patient outcomes,” says study author Dr. Robert Mentz – a cardiologist and assistant professor of medicine at Duke University Medical Center in Durham, NC.

Although depression has previously been associated with worse health outcomes for heart failure patients, most studies have only examined white patients. However, African-Americans are at an increased risk of heart failure compared with white people, according to the authors of the study.

Heart failure occurs when the heart is unable to pump enough blood and oxygen around the body to support vital organs. In 2009, 1 in 9 deaths in the US were attributable to heart failure. High blood pressure, obesity and diabetes are three major risk factors for heart failure, and all three disproportionately affect African-Americans.

For the study, the participants answered questions about their emotional health using a test validated for measuring depression. Participants scoring 14 or more on the test were considered to have clinical depression.

At the beginning of the study, depressive symptoms such as fatigue, lack of energy and feelings of hopelessness were recorded both at the start of the study and after 3 months. Around one third of the African-American participants reported symptoms associated with clinical depression as the study commenced.

The researchers then examined the associations between depressive symptoms at the start of the study and changes in symptoms in relation to the health outcomes of the participants. Other variables such as age, gender, other medical conditions and severity of heart failure were adjusted for.

Only 22% of African-American patients took antidepressant medication

Moderate depressive symptoms were found to raise the risk of African-American heart failure patients dying or being hospitalized. The risk of death and hospitalization increased for African-American patients reporting levels of depression even below those used to diagnose clinical depression.

African-American patients had a 33% higher risk of hospitalization or dying when symptoms of depression grew worse over the 3 months in comparison with patients whose depressive symptoms remained stable.

“These results suggest the potential importance of screening all heart failure patients with simple questions about their mood and depression at every health appointment, so their depression can be identified and treated,” says Dr. Mentz.

The authors acknowledge that their study is a retrospective analysis and, therefore, cannot be used to determine causality. After adjusting for variables, other unmeasured factors could still have influenced the findings. Additionally, they state that further study is needed to determine whether worsening depression is a cause or consequence of heart failure progression.

Despite these limitations, the authors believe their findings suggest the importance of attention to even modest baseline symptoms of depression.

Of additional concern is the finding that, although depression is common among both white patients and African-American patients, in the study, only 22% of African-American participants were taking antidepressant medications, in comparison with 42% of white patients.

“Further studies are needed to investigate the optimal treatment approaches for depression in [African-American] patients with [heart failure],” conclude the authors.

Recently, Medical News Today reported on a study suggesting that divorce could raise the risk of heart attack among women. The authors of which, however, state that it is unclear how the incidence of divorce over a lifetime may influence the risk of heart attack.