Journal of Cardiac Failure
Volume 13, Issue 8 , Pages 643-648, October 2007

Symptoms, Depression, and Quality of Life in Patients With Heart Failure

  • David B. Bekelman, MD, MPH

      Affiliations

    • Department of Medicine, Division of General Internal Medicine, University of Colorado at Denver and Health Sciences Center, Denver, Colorado
    • Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Denver, Colorado
    • Corresponding Author InformationReprint requests: David B. Bekelman, MD, MPH, Division of General Internal Medicine, B180, Academic Office 1 (AOW), Room #L15-8519, University of Colorado at Denver and Health Sciences Center, P.O. Box 6511, Aurora, CO 80045.
    • ,
  • Edward P. Havranek, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Denver Health Medical Center, Denver, Colorado
    • ,
  • Diane M. Becker, ScD, MPH

      Affiliations

    • Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • ,
  • Jean S. Kutner, MD, MSPH

      Affiliations

    • Department of Medicine, Division of General Internal Medicine, University of Colorado at Denver and Health Sciences Center, Denver, Colorado
    • ,
  • Pamela N. Peterson, MD, MSPH

      Affiliations

    • Division of Cardiology, Department of Medicine, Denver Health Medical Center, Denver, Colorado
    • ,
  • Ilan S. Wittstein, MD

      Affiliations

    • Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
    • ,
  • Sheldon H. Gottlieb, MD

      Affiliations

    • Division of Cardiology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
    • ,
  • Traci E. Yamashita, MS

      Affiliations

    • Department of Medicine, Division of General Internal Medicine, University of Colorado at Denver and Health Sciences Center, Denver, Colorado
    • ,
  • Diane L. Fairclough, DrPh

      Affiliations

    • Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Denver, Colorado
    • ,
  • Sydney M. Dy, MD, MSc

      Affiliations

    • Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

Received 20 November 2006; received in revised form 18 May 2007; accepted 24 May 2007.

Abstract 

Background

Little is known about symptoms and their burden in outpatients with chronic heart failure. Diverse symptoms may be associated with poor heart failure-related quality of life, and depression may be related to increased symptoms.

Methods and Results

The number of symptoms and symptom distress (physical symptoms on the Memorial Symptom Assessment Scale-Short Form), depression (Geriatric Depression Scale-Short Form), and heart failure-related quality of life (Kansas City Cardiomyopathy Questionnaire) were measured cross-sectionally in 60 patients with heart failure from two outpatient cardiology clinics. Patients experienced a mean of nine symptoms in the previous week. More than half reported shortness of breath, lack of energy, pain, feeling drowsy, or dry mouth. In unadjusted analyses, more severe depression was associated with a greater number of symptoms (r = 0.51, P < .0001) and greater overall symptom distress (r = 0.58, P < .0001). For each additional depression symptom, the number of symptoms reported increased by 0.6 after adjustment for age, race, and N-terminal pro-brain natriuretic peptide (P = .01). The number of symptoms accounted for 32% of the variance in quality of life (P < .0001).

Conclusions

Patients with heart failure report a large number of distressing symptoms. Depression in patients with heart failure is associated with a greater number of symptoms, which in turn is associated with a decrease in heart failure-related quality of life. Treatment of depression and the diverse symptoms reported by patients with heart failure might significantly improve quality of life.

Key Words: Quality of life, depression, symptoms, heart failure, palliative care

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 The study was funded by the Johns Hopkins Center for Complementary and Alternative Medicine; Johns Hopkins General Clinical Research Center; and National Center for Complementary and Alternative Medicine, National Institutes of Health.

PII: S1071-9164(07)00167-4

doi:10.1016/j.cardfail.2007.05.005

Journal of Cardiac Failure
Volume 13, Issue 8 , Pages 643-648, October 2007

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