Heart Failure and Incident Late-Life Depression

OBJECTIVES To assess whether heart failure (HF) increases the risk of developing depression and whether the use of loop diuretics in persons with HF alters this risk. DESIGN Population-based cohort study between 1993 and 2005. SETTING Ommoord, a district of Rotterdam, the Netherlands. PARTICIPANTS Five thousand ninety-five older adults free of depression at baseline. MEASUREMENTS Detailed information on HF and depression was collected during examination rounds and through continuous monitoring of medical and pharmaceutical records. HF was defined according to the criteria of the European Society of Cardiology. Depressive episodes were categorized as clinically relevant depressive symptoms and depressive syndromes, including major depressive disorders defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Hazard ratios (HRs) were calculated using multivariate Cox proportional hazard regression. RESULTS HF was associated with greater risk of depressive symptoms and syndromes (HR=1.41, 95% CI=1.03-1.94) and depressive syndromes only (HR=1.66, 95% CI=1.09-2.52). In participants with HF, the use of loop diuretics was associated with a lower risk of depressive symptoms and syndromes (HR=0.46, 95% CI=0.22-0.96) and depressive syndromes only (HR=0.41, 95% CI=0.16-1.00). CONCLUSION HF is an independent risk factor for incident depression in elderly persons. Patient with HF require careful follow-up to monitor and prevent the onset of depression. Effective treatment of the debilitating symptoms of HF may prevent depression.