Bidirectional relationship between depression and frailty syndrome in Heart Failure patients

Abstract

Introduction Depression and frailty syndrome (FS) are frequently identified in patients with heart failure (HF) and reported in the literature. The co-occurrence of depression and FS has several pathophysiological mechanisms. Moreover, the two constructs overlap in patients with cardiovascular disease. Depression may be difficult to diagnose in patients with HF due to the co-occurrence of FS, and vice versa. It therefore becomes important to establish the direction of the relationship between the presence of depression and FS in patients with HF. Understanding the relationship and causality between these modifiable variables provides an opportunity to increase patient psychological well-being as well as improve clinical outcomes. Aim of the study Determining the direction of the relationship between depression and FS in patients with HF. Material and Methods The study included 250 patients with HF (69% male, 31% female, mean age: M±SD=72.32±6.73). Data were collected during hospitalization. 50% of patients with HFrEF and 50% of patients with HFpEF were included. Depression was assessed using PHQ-9 (The Patient Health Questionnaire-9). The frailty phenotype was determined using the FRIED criteria (weight loss, feelings of exhaustion, decreased physical activity, slowed gait speed, weakened handgrip strength). The diagnosis of frailty was established when a minimum of 3 criteria were met. Data were considered statistically significant at p-value < 0.05. Results FS was identified in 60% of patients with HF. Patients with FS were older (73.58 ± 6.80 vs. 70.39 ±6.16, p-value=0.0002). In HFrEF patients, the mean PHG-9 score was M±SD=5.97±5.65. In HFpEF patients M±SD=5.85±4.52. There were no differences between patients with preserved and reduced left ventricular fraction in terms of PHQ-9 score (p-value=0.585). Univariate analysis showed that each additional score on the PHQ-9 raised the FRIED score by an average of 0.072 points (0.072; 95% CI: 0.051-0.093, p-value< 0.001) and each additional score on the FRIED scale raised the level of depression according to the PHQ-9 by an average of 2.124 points (2.124; 95% CI: 1.499-2.748, p-value<0.001). In the multivariate model, each additional score on the PHQ-9 raised the FRIED scale score by an average of 0.048 points. (0.048; 95% CI: 0.013-0.083, p-value=0.008) and each additional score on the FRIED scale raised the level of depression according to the PHQ-9 by an average of 0.68 points (0.68; 95% CI: 0.179-1.182, p-value=0.008). Conclusions The co-occurrence of FS and mild depression is identified in hospitalized with HF. There is a bidirectional relationship between frailty and depression in patients with HF: depression increases frailty and vice versa. Recognizing these two constructs during hospitalization should involve providing multidisciplinary continuity of care to prevent rehospitalizations.