Influence of depression and gender on symptom burden among patients with advanced heart failure: Insight from the pain assessment, incidence and nature in heart failure study.
Christine A Haedtke, Debra K Moser, Susan J Pressler and 3 others
PMID 30879736WHAT IT FOUND
Advanced heart failure patients with PHQ-9 depression scores 10 or higher had mean total symptom burden score 137 on a 0-416 scale, versus 70 below 10.
Depression was the strongest factor linked to burden. No treatment was tested.
Key findings
01Patients with depression scores of 10 or higher reported a mean grand total symptom burden of 137, versus 70 for scores below 10.
02Women had greater symptom burden than men for pain other than chest pain, feeling nervous, dry mouth, nausea, vomiting, sweats and swelling of arms and legs; men had greater burden from sexual problems; grand total burden did not differ by sex.
03Depression and education were the only significant explanatory variables of grand total symptom burden, and depression accounted for most of the explained variance.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational analysis, not a treatment study, so it cannot show whether treating depression would reduce symptoms. The sample was mainly White (79%), so results may not apply to other racial groups. There were far fewer women than men (35% vs 65%), which may have influenced gender findings. Most patients with reduced ejection fraction were already on optimal medical therapy (92%), so results may not apply to patients not receiving guideline-directed treatment. Many comparisons were made across 32 symptoms, which increases the chance that some individual symptom differences occurred by chance. Only 323 patients with complete data were included in regression, and the paper does not report how missing data were handled beyond pairwise deletion.
Declared interests
The supplied text does not include a conflict-of-interest or funding declaration. The publication types list NIH extramural research support.
The easy way to misread this
Do not conclude that treating depression will lower symptom burden. This was an observational study of patients already receiving heart failure care, and no depression treatment was tested; it only shows that higher PHQ-9 depression scores were associated with higher reported symptom burden.