Depressive symptoms increase risk of rehospitalisation in heart failure patients with preserved systolic function

Aims. To examine the impact of depressive symptoms on rehospitalisation for heart failure exacerbation in patients with preserved systolic function. Background. Depressive symptoms associated with higher risk of rehospitalisation have been primarily demonstrated in heart failure patients with systolic dysfunction (ejection fraction <40%) and the factors influencing rehospitalisation of patients with preserved systolic function (ejection fraction ≥40%) remain unclear. Design. A prospective, descriptive study design was used. Methods. The following baseline data were collected from 165 patients with preserved systolic function during an index hospitalisation for heart failure in South Korea: age, gender, body mass index, New York Heart Association functional class, the ratio of mitral velocity to early diastolic velocity of the mitral annulus, comorbidities, history of prior admission and depressive symptoms. Patients were followed monthly for six months after discharge to collect date on all rehospitalisation for heart failure exacerbation. Hierarchical Cox proportional hazards regression was used to identify independent predictors of rehospitalisation. Kaplan-Meier survival curves with log-rank test were used to determine differences in time to rehospitalisation according to severity of depressive symptoms. Results. Almost half of the patients (48%) had moderate to severe depressive symptoms. The ratio of mitral velocity to early diastolic velocity of the mitral annulus (hazard ratio = 1·06, 95% confidence interval = 1·02-1·10) and depressive symptoms (hazard ratio = 1·05, 95% confidence interval = 1·02-1·08) independently predicted rehospitalisation after controlling for other risk factors. Moderate and severe depressive symptoms were associated with both a higher rate and shorter time to rehospitalisation. Conclusions. Moderate to severe depressive symptoms predict early rehospitalisation for heart failure exacerbations in patients with preserved systolic function. Relevance to clinical practice. Nurses should assess for depressive symptoms in patients with heart failure and refer those with depressive symptoms for treatment to improve outcomes.