Relationship of depressive symptoms to the impact of physical symptoms on functional status in women with heart failure

Background: Among patients with heart failure, women have worse functional status than do men, but little research has focused on determining factors that influence functional status in either sex. Objectives: To compare factors that influence functional status in men and women with heart failure and to test whether depressive symptoms mediate the relationship between physical symptoms and functional status. Methods: A cross-sectional, descriptive study design was used. A total of 231 patients, 133 men and 98 women, were recruited from an inpatient heart failure clinic in South Korea. Functional status (the Korean Activity Scale/Index), physical symptoms (the Symptom Status Questionnaire), depressive symptoms (the Beck Depression Inventory), and situational factors (living status, socioeconomic status) were measured. Hierarchical multiple regression and mediation analysis were used for data analysis. Results: Women (mean score, 24.5; SD, 17.3) had worse functional status than did men (mean score, 31.9; SD, 20.1; P =.004). Dyspnea on exertion (β = -0.16), ankle swelling (β = -0.19), fatigue (β = -0.20), and depressive symptoms (β = -0.19) were independently associated with functional status in women, whereas only dyspnea on exertion (β = -0.30) influenced functional status of men in hierarchical multiple regression analysis. Mediation analysis indicated that depressive symptoms mediated the relationship between physical symptoms and functional status in women with heart failure, but not in men. Conclusions: Distinct physical and psychological symptoms influence functional status in women with heart failure. A systematic multidimensional intervention may be required to target depressive symptoms to improve functional status in women with heart failure.