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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study aims to estimate the prevalence and correlates of major depressive disorder (MDD) in Nigerian outpatients with heart failure. Authors assessed patients with heart failure (N = 102) for DSM-IV diagnosis of MDD and obtained sociodemographic and clinical data. MDD was found in 28 (27.5%) of the patients. The significant correlates predicting MDD included unemployment and disability due to the illness, more severe illness (NYHA class), age younger than 60 years, and not being married. These factors should be considered in planning further studies and in screening and intervention programs for patients with heart failure.
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PMID:Prevalence and correlates of major depressive disorder in Nigerian outpatients with heart failure. 1711 48

The purpose of this study was to examine conjoint trajectories of depression-physical illness in elderly medical inpatients with heart failure and/or chronic pulmonary disease and major depression (MDD), and to identify baseline predictors of trajectory. Consecutive medically hospitalized patients over age 50 with heart failure and/or chronic pulmonary disease were screened for MDD using the Structured Clinical Interview for Depression. Patients were re-evaluated at 6, 12, 18, and 24 weeks. Four depression-physical illness conjoint trajectories were examined: depression better, illness better; depression better, illness same; depression same, illness better; and depression same, illness same. Baseline predictors of trajectory were examined. MDD was identified in 413 patients; 352 had at least one follow-up. By 6 weeks, 22.3% improved on both depression and illness and 38.1% improved on neither. By 24 weeks, 45.0% had improved on both and 24.8% on neither. Short-term baseline predictors of trajectory (6 weeks) differed from long-term (12-24 weeks); past psychiatric history, overall medical illness severity, and education were short-term predictors, whereas past psychiatric history, depression treatments, and physical functioning were long-term. Improvements in MDD and physical illness track closely together. Characteristics during baseline hospitalization predict outcome trajectory after discharge, and may be useful in understanding etiology and directing treatment.
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PMID:Major depression and physical illness trajectories in heart failure and pulmonary disease. 1716 29

Cognitive deficits are common in association with heart failure (HF), and it is possible that their severity is magnified by the concomitant presence of major depressive disorder (MDD). Using the Cambridge Mental Disorders of the Elderly Examination battery, the authors compared the cognitive performance of MDD-HF subjects (N=20), nondepressed HF subjects (N=23), and healthy control subjects (N=18). Scores were lower in both HF groups relative to control subjects. In the MDD-HF group, there were significant cognitive improvements after antidepressant treatment. Cognitive impairment is, therefore, significant in HF subjects with or without comorbid MDD, and it is important to recognize and treat MDD symptoms associated with HF.
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PMID:Effects of antidepressant treatment on cognitive performance in elderly subjects with heart failure and comorbid major depression: an exploratory study. 1720 46

Chronic illness accounts for the majority of healthcare expenditures in the United States. Innovative telemedicine programs have been developed to help lessen the chronic illness burden, yet few have been developed to address comorbidity. Programs accommodating comorbidity are needed because most older adults suffer from two or more chronic illnesses. One of the most common and serious comorbidities in chronic illness is major depression, which has been shown to exacerbate morbidity, mortality, and cost. This study presents data on a telephone-based interactive voice recording (IVR) home monitoring program that was expanded to include quarterly screens for depression using the Patient Health Questionnaire (PHQ). Patients in an ongoing telehealth heart failure program were administered the PHQ-2 and PHQ-9 in November 2005 (Round 1) and February 2006 (Round 2). Patients were informed about the screen beforehand and an emergency protocol was established. At both screens, more than 90% of the patients completed the screen. Approximately 30% of the patients endorsed one of the PHQ-2 items in both rounds. Patients endorsing either of the PHQ-2 items then completed the full PHQ-9. Nurse care-managers contacted those scoring above the threshold of 10 on the PHQ-9 indicating possible depression. One patient expressed suicidality and was appropriately assessed for safety. There was no indication that patients were less likely to complete the screen in Round 2, although their average depression scores were slightly lower when compared with Round 1. A regular telephonic IVR screen for depression can be integrated into a standard illness management protocol. Following a preestablished emergency plan for the assessment of suicidality was successful. This serves as a model for using technology to manage comorbid depression and chronic illness.
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PMID:Telehealth screen for depression in a chronic illness care management program. 1730 55

Patient satisfaction has been used as a healthcare quality indicator. We examined how depression and pain severity affected satisfaction in medical outpatients. Data from the Medical Outcomes Study were analyzed. The primary outcomes were seven satisfaction domains from the Patient Satisfaction Questionnaire. Depression was identified through a clinical interview, and pain was assessed with the 36-item Short Form Bodily Pain scale. We performed multivariate linear regression to predict satisfaction in outpatients with depression and pain. Minor and major depression were present in 23.4% and 15.0% of the sample, respectively. Pain was present in more than half the patients (50.6%). Both minor and major depression as well as pain severity were strongly associated with lower satisfaction scores. Increased age and diagnosis of heart failure predicted higher satisfaction scores. Depression and pain have a substantial effect on patient satisfaction. Future studies should assess the reasons for dissatisfaction with care in patients with depression and pain.
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PMID:Effects of depression and pain severity on satisfaction in medical outpatients: analysis of the Medical Outcomes Study. 1755 69

The authors evaluated levels of inflammatory markers in 34 chronic heart failure (CHF) out-patients age 65 years and over, with (N=18) and without (N=16) major depressive disorder (MDD), and healthy-control subjects (N=13). Patients with CHF had left-ventricular ejection fractions <0.40 and were in the New York Heart Association functional class II or III. The authors used the SCID DSM-IV to diagnosis MDD. High-sensitivity C-reactive protein levels were significantly higher in patients with CHF and MDD as compared with healthy-control subjects. No differences regarding tumor necrosis factor(alpha) or interleukin(6) were found among the three groups.
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PMID:Major depressive disorder and inflammatory markers in elderly patients with heart failure. 1760 Jan 68

A major depressive episode is diagnosed based on several well-defined criteria as the presence of depressed mood and loss of interest. According to a large meta-analysis the prevalence of major depression in patients with chronic heart failure is more than 20%. Etiological factors include individual (genetic) disposition and social environment as well as psychosocial stress and biological risk factors related to the chronic cardiac illness. As in coronary artery disease, mortality rates are increased in patients suffering from heart failure and comorbid depression. Possible mechanisms mediating this relationship include both biological (e.g. severity of chronic heart failure, autonomic and immunological dysregulation, multiple comorbidities) and behavioral factors (health behavior, compliance with pharmacological and non-pharmacological therapy). Shared pathophysiological mechanisms as well as a common genetic disposition are also discussed. Simple screening instruments and effective treatment options (psychotherapy, selective serotonin re-uptake inhibitors) are available. However, at present evidence is lacking that beyond improvement of depression these strategies impact favorably on morbidity and mortality.
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PMID:[Depression in chronic heart failure: complication, risk factor or autonomous disease?]. 1830 72

Major depression is found in one fifth of heart failure patients, and clinically significant depressive symptoms in almost half. The association of depression and heart failure appears to be related both to the psychological aspects of severe heart disease, and to pathophysiological and psychosocial mechanisms. The presence of depression is associated with a worsening of the prognosis, and increased risk of death, rehospitalization, and functional decline. Detection and treatment of depression should be part of a comprehensive approach to heart failure patients by cardiologists and family doctors. Good quality cardiac care should include psychosocial assessment, strengthening of the doctor-patient relationship and of family and social bonds, and, when appropriate, antidepressants and psychotherapy. Selective serotonin reuptake inhibitors are effective and safe antidepressants in cardiac patients. They should be prescribed in therapeutic doses until sustained remission is obtained. Collaboration between psychiatrists and other specialists at primary and secondary care levels is recommended and contributes to better quality care.
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PMID:Heart failure and depression: an association with clinical importance. 1844 41

The purpose of this study was to examine the association between dependence in activities of daily living (ADL) and instrumental ADL (IADL) and major depression among 415 community-dwelling primary care patients age 65+ with heart failure and significant ADL or IADL dependence. Main findings include (1) a progressive increase in depression prevalence from 0% for no IADL dependence to about 40% for 6 IADL dependencies (P < .001), (2) a steady rise in depression prevalence to 40% for 6 ADL dependencies following a "floor effect" at about 10% for 0 to 2 ADL dependencies (P < .001), and (3) the association in a logistic regression model of major depression with number of IADL dependencies (P = .016) but not with number of ADL dependencies (P = .602). Our principal conclusion is that the progressively greater likelihood of major depression as the number of IADL dependencies increases has important clinical, personal, social, and public health relevance.
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PMID:Major depression and disability in older primary care patients with heart failure. 1847 20

In order to assess the relationships among mood, peripheral autonomic output and circulating immunoinflammatory mediators in older individuals with decompensated heart failure (CHF), 20 consecutive patients (78+/-7 years, 35% women) admitted to the coronary care unit with a clinical diagnosis of acute/decompensated CHF of coronary origin were examined. Mood was evaluated by the 21-item Hamilton Depression Scale (HAM-D). Four patients met the criteria for major depression. Heart rate variability (HRV) analysis and the levels of tumour necrosis factor (TNF)-alpha, interferon (IFN)-gamma, interleukin (IL)-2, IL-4, IL-6 and IL-10 were measured within 24-72 h of admission. A significant positive relationship between score in HAM-D and serum IL-6 levels was detected with a similar trend as far as IL-2 levels. Circulating IL-2 levels were strongly associated with the HRV L/H quotient, an index of increased sympathetic and/or decreased parasympathetic thoracic activity. A negative correlation between vagal activity (as assessed by HRV) and IL-4 occurred. Neither TNF-alpha nor IL-10 were detectable in this group of elderly patients. The results add to the concept that mood and autonomic unbalance are associated with increased systemic inflammation in old patients with decompensated CHF, a potential mechanism for mood-related worsened prognosis of heart failure at an advanced age.
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PMID:Mood, Th-1/Th-2 cytokine profile, and autonomic activity in older adults with acute/decompensated heart failure: preliminary observations. 1893 52


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