1. College of Nursing ● University of Kentucky ● Lexington, KY
The Association of Comorbid Diabetes Mellitus and Symptoms of Depression with All-Cause Mortality and Cardiac Rehospitalization in Patients with Heart Failure
Abdullah S. Alhurani, PhDc, MSN, RN, Geri Reeves, PhD, RN, Susan K. Frazier, PhD, RN, Terry A. Lennie, PhD, RN, FAAN, Debra K. Moser, DNSc, RN, FAAN
College of Nursing ● University of Kentucky ● Lexington, KY
Background
Diabetes Mellitus (DM) is a significant clinical problem that is found in a substantial number of patients with heart failure (HF); around 20% of patients who have HF have DM compared to approximately 6% in patients without HF. In addition, patients with HF experience multiple psychological symptoms such as depression which also been independently associated with survival. Although advances in treatment, DM and depression are remain independent predictors of mortality and rehospitalization among HF patients. Whether co-morbid symptoms of DM and depression are associated with outcomes in patients with HF is unknown.
Objective
The aim of this study was to determine whether co-morbid symptoms of DM and depression are associated with all-cause mortality or rehospitalization for cardiac causes in patients with HF.
Method
A total of 663 HF patients participated. Cox regression analysis was used to determine whether co-morbid symptoms of DM and depression independently predicted all-cause mortality and cardiac rehospitalization. Patients were divided into four groups based on the presence of DM and depression symptoms. (1) patients with no DM and with no depressive symptoms, (2) patients with no DM and with depressive symptoms, (3) patients with DM and no depressive symptoms, and (4) patients with DM and with depressive symptoms.
Discussion
Presence of DM affects both the relationship between depressive symptoms and the outcome of patients with HF, by demonstrating that HF patients with DM and the presence of depressive symptoms have shorter event free survival time compared to no DM and depressive symptoms, or symptoms of DM or depression alone. Future studies needed to examine the contribution of behavioral and physiological causes of poor outcomes in HF patients with co-morbid DM and depressive symptoms.
Results
Co-morbid symptoms of DM and depression (versus no symptoms, or symptoms of DM or depression alone) independently predicted all-cause mortality (HR 2.67; 95% CI: ; p = 0.024). Depression alone variable was also independent predicted all-cause mortality (HR 2.47; 95% CI: ; p = 0.025). Furthermore, co-morbid symptoms of DM and depression (versus no symptoms, or symptoms of DM or depression alone) independently predicted cardiac rehospitalization (HR 2.80; 95% CI: ; p <0.001). None of the other DM and depression variables was a predictor of cardiac rehospitalization in HF patients.