Adult ; Aged ; Aged, 80 and over ; Comorbidity ; Cross-Sectional Studies ; Depression/diagnosis ; Depression/epidemiology* ; Disease-Free Survival ; Female ; Follow-Up Studies ; Heart Failure/epidemiology* ; Heart Failure/physiopathology ; Heart Failure/psychology* ; Humans ; Kaplan-Meier Estimate ; Male ; Malnutrition/diagnosis ; Malnutrition/epidemiology* ; Micronutrients/deficiency* ; Middle Aged ; Proportional Hazards Models ; Republic of Korea/epidemiology ; Severity of Illness Index ; Surveys and Questionnaires* ; Tertiary Care Centers ; Time Factors
Keywords
Depression ; nutrition ; outcomes
Abstract
BACKGROUND: Depressive symptoms and malnutrition independently predict cardiac events in heart failure (HF) patients. However, the relationships among depressive symptoms, nutritional intake, and cardiac event-free survival have not been examined.
METHODS AND RESULTS: A total of 232 patients with HF completed the Patient Health Questionnaire 9 (PHQ-9) to measure depressive symptoms and a 3-day food diary to determine the number of micronutrient deficiencies. Patients were followed for 2 years to collect data on cardiac event-free survival. Patients were divided into 4 groups by a PHQ-9 score of 10 and the median value of micronutrient deficiencies. Cox regressions were used to determine the relationships among depressive symptoms, micronutrient deficiency, and cardiac event-free survival. Depressive symptoms conferred greater risk of cardiac events in patients with a high number of micronutrient deficiencies than in those with a low number of micronutrient deficiencies. Patients with a PHQ-9 score ≥10 and number of micronutrient deficiencies >5 had 2.4 times higher risk for cardiac events compared with patients with a PHQ-9 score <10 and micronutrient deficiency ≤5 (P = .005).
CONCLUSIONS: There was a synergistic effect on the association of depressive symptoms with cardiac event-free survival in HF patients that differed by micronutrient deficiency.