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Depression significantly reduces the 6-minute walking distance in systolic heart failure: Insights from the ESCAPE trial

Published:January 26, 2017DOI:https://doi.org/10.1016/j.ejim.2017.01.009
      Over the past two decades, there has been an increased interest to study the relationship between depression and heart failure (HF) stemming from the fact that HF is the fastest growing entity of cardiovascular disease affecting 26 million patients worldwide and responsible for 1 million hospitalizations per year in the United States [
      • Ambrosy A.P.
      • et al.
      The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries.
      ], in addition to the high rates of depression reported among HF population in multiple studies [
      • Freedland K.E.
      • et al.
      Prevalence of depression in hospitalized patients with congestive heart failure.
      ]. The high morbidity and mortality in HF and the accompanying enormous healthcare costs stimulate research looking for predictors of poor performance and outcomes. The association between symptoms and physical function in patients with HF has been previously established in multiple studies [
      • Conley S.
      • Feder S.
      • Redeker N.S.
      The relationship between pain, fatigue, depression and functional performance in stable heart failure.
      ,
      • Sullivan M.
      • et al.
      Depression and health status in patients with advanced heart failure: a prospective study in tertiary care.
      ]. With progression of HF pathology, symptom burden increases, interfering with functional performance. We have previously examined four symptoms in patients hospitalized with acute HF: dyspnea, orthopnea, fatigue and gastrointestinal upset and found significant -though weak- association with 6-minute walk test (6MWT) [
      • Omar H.R.
      • Guglin M.
      The longitudinal relationship between six-minute walk test and cardiopulmonary exercise testing, and association with symptoms in systolic heart failure: Analysis from the ESCAPE trial.
      ]. Depression symptoms are prevalent in 21.6% of HF patients [
      • Rutledge T.
      • et al.
      Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes.
      ] which is 2 to 3 times higher than the rate of the general population [
      • Evans D.L.
      • et al.
      Mood disorders in the medically ill: scientific review and recommendations.
      ], and there is evidence that major depression and depressive symptoms are associated with increased mortality in HF [
      • Jiang W.
      • et al.
      Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure.
      ]. A recent study showed that depression relates to the functional performance in heart failure (HF) –defined as ability to perform activities of daily living – but did not limit the actual potential to perform normal activities as measured by the 6MWT [
      • Conley S.
      • Feder S.
      • Redeker N.S.
      The relationship between pain, fatigue, depression and functional performance in stable heart failure.
      ]. In this analysis, we aim to study the relationship between depression and 6MWT among patients hospitalized with acute systolic HF.

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