Depression is a major determinant of quality of life in patients with chronic systolic heart failure in general practice

Background: Quality of life (QoL) is severely restricted in patients with chronic heart failure (CHF). Patients frequently suffer from depressive comorbidity. It is not clear, to what extent sociodemographic variables, heart failure severity, somatic comorbidities and depression determine QoL of patients with CHF in primary care. Methods and Results: In a cross-sectional analysis, 167 patients, 68.2 +/- 10.1 years old, 68.9% male, New York Heart Association (NYHA) functional class II-IV Left ventricular ejection fraction (LVEF) <= 40%, were recruited in their general practitioner's practices. Heart failure severity was assessed with echocardiography and N-terminal brain natriuretic peptide (NT-proBNP); multimorbidity was assessed with the Cumulative Illness Rating Scale (CIRS-G). QoL was measured with the Short Form 36 Health Survey (SF-36) and depression with the depression module of the Patient Health Questionnaire (PHQ-9). Significant correlations with all SF-36 subscales were only found for the CIRS-G (r = -0.18 to -0.36; P <.05) and the PHQ-9 (r = -0.26 to -0.75; P <.01). In multivariate forward regression analyses, the PHQ-9 summary score explained the most part of QoL variance in all of the SF-36 subscales (r(2) = 0.17-0.56). LVEF and NT-proBNP did not have significant influence on QoL. Conclusions: Depression is a major determinant of quality of life in patients with chronic systolic heart failure, whereas somatic measures of heart failure severity such as NT-proBNP and LVEF do not contribute to quality of life. Correct diagnosis and treatment of depressive comorbidity in heart failure patients is essential.