Depression linked to worse outcomes in African Americans with heart failure

April 27, 2015 – Robert Mentz, MD, analyzed the outcomes of more than 2,100 heart failure patients enrolled in the HF-ACTION study.

African-American heart failure patients with even moderate symptoms of depression may be at increased risk of hospitalization or death.

A new study led by the DCRI’s Robert Mentz, MD (pictured), published in the journal Circulation: Heart Failure, concluded that identifying and treating these symptoms could improve outcomes for African-American patients.

robert-mentz-newsEarlier studies have established that depression is associated with worse outcomes for heart failure patients. Most of these studies, however, were conducted with white patients. Understanding how depression could affect outcomes for African-American heart failure patients could affect how such patients are treated. Other major risk factors for heart failure, such as high blood pressure, obesity, and diabetes, are already known to affect African Americans disproportionately.

For this study, Mentz and his colleagues examined the connection between symptoms of depression and outcomes among the patients enrolled in Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION). Throughout the study, these patients were asked to complete the Beck Depression Inventory II (BDI-II), a questionnaire about their emotional and mental health. These responses, in turn, were used to generate a numerical score for each patient. Patients with a score of 14 or higher were considered to have symptoms of depression. Patients were also asked about any antidepressants they were using.

Of the 2,167 patients enrolled in HF-ACTION, 747 (34 percent) were African-American and 1,420 (66 percent) were white. Approximately one-third of the African-American patients scored higher than 14 on the BDI-II at the beginning of the study. After four years of follow-up, 521 African-American patients (70 percent) and 922 (65 percent) white patients died or were hospitalized. Both white and African-American patients who had lower BDI-II score were more likely to have better clinical outcomes than those with higher scores.

However, African-American patients had a 33 percent higher risk of hospitalization or dying when symptoms of depression grew worse over 3 months, compared to patients whose depressive symptoms remained stable. The researchers also noted that only 22 percent of African-American patients in the study reported taking antidepressant medications, compared to 42 percent of white patients.

Further research is needed, the researchers concluded, to better understand the relationship between depression and outcomes among African-American heart failure patients and determine the best way to treat such patients.

The study’s other authors were Michael A. Babyak, PhD; Vera Bittner, MD, MSPH; Jerome Fleg, MD; Steven Keteyian, PhD; Ann Swank, PhD; Ileana Piña, MD, MPH; William Kraus, MD; David Whellan, MD, MHS; Christopher O’Connor, MD, and James Blumenthal, PhD.