Depressive symptoms are prominent in elderly hospitalized patients with heart failure and have been associated with decreased functional status, increased hospital readmissions and greater mortality. However, little is known about the characteristics of heart failure patients prone to depression and their treatment.

In this analysis of the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure)study, a multi-centre registry based in the US of some 48,612 patients at 219 hospitals, a history of depression was present in 10.6% of individuals.Depression was significantly more common in females, whites and those with concomitant diseases such as COPD and insulin-dependent diabetes.Patients with depression were much less likely to receive coronary interventions or cardiac devices or to be referred to outpatient disease management programs.

Due to the retrospective nature of the study, the authors are unable to comment on the reasons for these seeming disparities but these factors may go some way towards explaining the poorer outcomes of some patient groups. The randomized controlled trial MOOD-HF investigating the use of SSRIs in depressed heart failure patients will provide evidence based recommendations for management, but in the meantime an increased awareness of the impact of depression may provide an opportunity to improve outcomes in heart failure patients.

Nancy M. Albert, Gregg C. Fonarow, William T. Abraham et al. Depression and Clinical Outcomes in Heart Failure: An OPTIMIZE-HF Analysis. The American Journal of Medicine (2009) 122, 366-373