Background: Mental health illnesses are associated with frequent rehospitalisation and an increased risk of all-cause mortality. Despite the high prevalence of depression in patients with chronic heart failure (CHF), there is a paucity of data on this subject from low and middle-income countries (LMIC). This study aimed to determine the prevalence of depression, anxiety and stress symptoms in patients attending a dedicated chronic heart failure clinic.
Methods: A prospective study was conducted at an outpatient heart failure clinic in a tertiary academic centre. The study participants completed a Depression, Anxiety and Stress (DASS-21) questionnaire to screen for the presence and severity of depression, anxiety and stress symptoms. Furthermore, the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was completed and used to evaluate the impact of CHF on health-related quality of life. Descriptive statistics were used to describe patients' characteristics and logistic regression analysis to identify predictors of symptoms of depression.
Results: The study population comprised of 103 patients, predominantly female (62.1%) with a median age of 53 (interquartile range 38 – 61) years. Symptoms of depression were reported by 52.4%, with 11.7% reporting symptoms suggestive of extremely severe depression. Anxiety was diagnosed in 53.4% of patients and extremely severe anxiety reported by 18.4% of patients. Fifty patients were classified as stressed, and only 7.7% had extremely severe stress. More than half of the patients (54.4%) were in New York Heart Association (NYHA) functional class I with a mean (SD) left ventricular ejection fraction (LVEF) of 30.5% (11.1). In the multivariable logistic regression model, permanent employment [odds ratio (OR) -1.22, 95% CI:-0.01– -0.00, p=0.012], the six-minute walk test [OR -0.07, 95% CI: 0.02 – 0.06, p=0.001] and orthopnoea [OR 1.89, 95% CI: -0.01 – -0.00, p=0.012] were identified as independent predictors of depression.
Conclusion: Depression and anxiety symptoms were found in over half of patients attending the chronic heart failure clinic. We recommend that mental health screening should be routinely performed in patients with chronic heart failure. Prospective, adequately powered, multicentre studies from LMIC investigating the impact of depression, anxiety and stress on CHF hospitalisation and mortality are required.