Managing depression, fatigue in patients with heart failure may reduce hospital stays, mortality

A study in the American Journal of Critical Care (AJCC) examines the complex relationship between fatigue, depression and gender in patients with heart failure and the effect on hospitalization.

The study, "Differing Effects of Fatigue and Depression on Hospitalizations in Men and Women With Heart Failure," found that fatigue and depression may affect hospitalization separately but do not have synergistic effects. Men and women differ in the effects of these symptoms on hospitalization.

A team of researchers from the University of Arkansas for Medical Sciences (UAMS), Little Rock, reviewed data from the records of 9,869 patients who had been hospitalized for any reason at UAMS with a diagnosis of heart failure during a three-year period from Jan. 1, 2010, through Dec. 31, 2012. All study variables -- hospitalizations, demographic characteristics, vital signs, comorbid conditions, results of laboratory tests, clinical characteristics and medications -- were present in the records of 582 patients, allowing for further analysis related to fatigue and depression.

For the study, the researchers compared the effects of fatigue and depression on hospitalization in four groups of patients: fatigue-only, depression-only, both depression and fatigue, and those without fatigue or depression.

In the total sample and gender-specific subgroups, patients with both fatigue and depression were hospitalized more than those without either condition. They also had more visits to the emergency department and longer lengths of stay.

The researchers found a lack of synergistic effects of fatigue and depression on the number of hospitalizations, since patients with both symptoms had more hospitalizations than those without either condition, but they did not have more hospitalizations than the depression-only group or the fatigue-only group. However, female patients with either depression or fatigue and male patients with fatigue-only had more hospitalizations than those without either condition.

"Our research provides a good picture of the relationships of fatigue and depression to all-cause hospitalizations of heart failure patients," said co-author Seongkum Heo, RN, PhD, associate professor at the UAMS College of Nursing. "Fatigue needs to be addressed in patients with heart failure, and depression needs to be managed, especially in women. Doing so could help reduce hospitalizations, improve outcomes and lower costs."

Among the findings:

• About 44 percent of the sample did not experience fatigue and depression; 29.7 percent had fatigue only; 10.7 percent had depression only; and 15.6 percent had both fatigue and depression. Thus, 45.3 percent had a diagnosis of fatigue, and 26.3 percent had a diagnosis of depression.

• A diagnosis of fatigue was significantly associated with a greater number of all-cause hospitalizations in both men and women.

• A diagnosis of depression was significantly associated with a greater number of all-cause hospitalizations in women only.

• The both-symptoms group was older and had lower heart rates, lower diastolic blood pressure and higher left ventricular ejection fraction than all other groups.