Depression Subtypes in Patients with Systolic Heart Failure: A Secondary Analysis from the Randomized Controlled Hopeful Heart Trial
Abstract
Objective Heart failure (HF) is associated with an elevated risk of morbidity, mortality, hospitalization, and impaired quality of life (QoL). One potential contributor to these poor outcomes is depression. Yet the effectiveness of treatments for depression in HF patients is mixed, perhaps due to the heterogeneity of depression. Methods This secondary analysis applied latent class analysis (LCA) to data from a clinical trial to classify patients with systolic HF and co-morbid depression into LCA subtypes based on depression symptom severity, and then examined whether these subtypes predicted treatment response and mental and physical health outcomes at 12-months follow-up. Results In LCA of 629 participants (mean age 63.6±12.9; 43% females), we identified four depression subtypes: mild (prevalence 53%), moderate (30%), moderately severe (12%), and severe (5%). The mild subtype was characterized primarily by somatic symptoms of depression (e.g., energy loss, sleep disturbance, poor appetite), while the remaining LCA subtypes additionally included non-somatic symptoms of depression (e.g., depressed mood, anhedonia, worthlessness). At 12 months, LCA subtypes with more severe depressive symptoms reported significantly greater improvements in mental QoL and depressive symptoms compared to the LCA mild subtype, but the incidence of cardiovascular- and non-cardiovascular-related readmissions, and mortality was similar among all subtypes. Conclusions In depressed patients with…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 629 participants or records.
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