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Depression is independently associated with increased risk for heart failure, even without other cardiovascular risk factors, according to recent research.

Depression is independently associated with elevated risk for developing heart failure (HF), including among those without other cardiovascular risk factors, according to a recent analysis of Veterans Affairs (VA) Birth Cohort data encompassing more than 2.8 million US veterans, published in JAMA Network Open.

“As the US population ages, the prevalence of heart failure (HF) continues to increase, with approximately 6.7 million adults with HF (according to 2017-2020 data),” wrote study author Jamie Pfaff, MD, Vanderbilt University Medical Center, and colleagues. “Among patients with HF, at least 1 in 5 experience depression, a comorbid condition associated with higher rates of hospitalization and mortality.”

Noting that the role of depression as a potential precursor to incident HF has not been widely studied, the study authors examined the association between incident HF and prevalent depression among veterans.

Large-Scale Data, Nuanced Findings

The study cohort included 2,843,159 veterans born between 1945 and 1965, with no diagnosis of HF at baseline. Researchers tracked incident HF using inpatient and outpatient diagnosis codes from the VA and Medicare databases. The study team similarly defined depression using diagnosis codes. Over a median follow-up period of nearly seven years, veterans with prevalent depression had a significantly higher incidence of HF than those without depression (136.9 vs 114.6 cases per 10,000 person-years).

“Participants with depression demonstrated higher unadjusted incident HF rates compared with those without depression (136.9 [95% CI, 132.2-141.7] cases per 10,000 person-years vs 114.6 [95% CI, 113.4-115.9] cases per 10,000 person-years, respectively),” the researchers reported. “After adjusting for sociodemographic and cardiovascular risk factors, depression was associated with an increase in incident HF hazard of 14.0% (hazard ratio [HR], 1.14; 95% CI, 1.13-1.16), with an estimated adjusted median (IQR) incidence rate difference of 16.0 (14.9-18.3) cases per 10 000 person-years.”

According to findings, depression among patients without comorbidities was associated with a higher increase in incident HF hazard (HR, 1.58; 95% CI, 1.39-1.80), with an estimated adjusted median (IQR) rate difference of 14.2 (9.5-19.5) cases per 1,000 person-years.

The association persisted in multiple sensitivity analyses, including one with a time-dependent depression status and another among a low-risk cohort without other associated comorbidities at baseline in whom depression was associated with a 58% increased hazard of HF.

Implications for Screening & Treatment

The research team acknowledged the study’s observational design and its limitations, particularly the reliance on diagnostic coding. Nevertheless, they concluded that “depression was associated with an increased hazard of incident HF after controlling for traditional sociodemographic and cardiovascular risk factors,” emphasizing the need for further research to assess whether early recognition and treatment of depression could lower the risk of heart failure and enhance patient outcomes.

“The current American College of Cardiology and the American Heart Association clinical practice guidelines recommend evaluation of symptoms of depression in patients with HF due to risk of poor self-care, rehospitalization, and all-cause mortality,” the authors stated. “Our findings support these recommendations for enhanced vigilance in assessment of HF signs and symptoms among patients with depression.”