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

https://doi.org/10.1016/j.cardfail.2007.05.005Get rights and content

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.

Section snippets

Study Population

Participants were recruited from outpatient cardiology clinics at an academic-affiliated community hospital and a tertiary care academic referral hospital in Baltimore, Maryland, between August 2004 and April 2005. Eligible study participants (1) had a cardiologist's diagnosis of heart failure, (2) had a cardiologist's assigned NYHA functional class II, III, or IV, and (3) were age 60 years or older. Patients were excluded if they were (1) diagnosed with dementia, (2) unable to understand the

Results

The study population is described in Table 1. The median age of participants was 75 years, and a minority were female (37%) and African-American (12%). The median health status (KCCQ) score was 71, which has been associated with NYHA class II.18 Thirty-two percent had current probable depression according to a standard cutoff score on the GDS-SF. Although there were only seven African-Americans enrolled in the study, they were more likely to have a greater number of symptoms (median of 16

Discussion

We found that patients with heart failure reported a large number of distressing symptoms that were associated with depression and worse quality of life. Many of the symptoms reported are not generally thought of as being caused by heart failure. Some of these symptoms may be associated with medications used to treat heart failure, such as dry mouth (reported by 50% of patients in our sample) or constipation (reported by 30%). Others may be associated with comorbid illnesses, and yet others may

Conclusions

Depression in patients with heart failure is associated with a greater number of symptoms, which in turn is responsible for a major portion of the decrease in quality of life associated with heart failure. The substantial decrease in quality of life attributed to symptoms has several implications for clinicians. First, strategies to improve the quality of life in patients with heart failure may require that clinicians ask about and address patients' symptoms beyond those generally associated

References (34)

  • S.S. Gottlieb et al.

    A double-blind placebo-controlled pilot study of controlled-release paroxetine on depression and quality of life in chronic heart failure

    Am Heart J

    (2007)
  • J.S. Kutner et al.

    Symptom distress and quality-of-life assessment at the end of life: the role of proxy response

    J Pain Symptom Manage

    (2006)
  • I.B. Wilson et al.

    Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes

    JAMA

    (1995)
  • E. Hing et al.

    National Ambulatory Medical Care Survey: 2004 summary

    Adv Data

    (2006)
  • K. Kroenke et al.

    The prevalence of symptoms in medical outpatients and the adequacy of therapy

    Arch Intern Med

    (1990)
  • H. Patel et al.

    Reasons for seeking acute care in chronic heart failure

    Eur J Heart Fail

    (2007)
  • C.H. Zambroski et al.

    Impact of symptom prevalence and symptom burden on quality of life in patients with heart failure

    Eur J Cardiovasc Nurs

    (2005)
  • Cited by (0)

    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.

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