Association between depression and heart failure: A meta-analysis of cohort studies with 2.6 million participants

TL;DR

A meta-analysis of 2.6 million people found that depression may increase the risk of developing heart failure, though the evidence quality is very low.

Contribution

This study provides a comprehensive meta-analysis linking depression to heart failure using a large cohort of participants.

Findings

Depression is a statistically significant risk factor for heart failure (HR: 1.25, 95% CI: 1.13, 1.38).

The association remains significant across various subgroup and sensitivity analyses.

The certainty of evidence is rated as 'very low' based on GRADE assessment.

Abstract

Depression is a widely prevalent mental disorder that has been linked to several systemic diseases. While a relationship has been established between depression and cardiovascular diseases, the risk of heart failure (HF) in depressed patients is unclear. Herein, we collated evidence from cohort studies to establish the link between depression and HF.

PubMed, Embase, CENTRAL, Web of Science and Scopus were searched up to 28 July 2024 for cohort studies excluding baseline HF patients and reporting adjusted effect size of the association between depression and HF after a minimum follow-up of five years. A random-effect meta-analysis was conducted.

Eleven studies with 2,635,205 participants were included. Pooled analysis showed that depression was a statistically significant risk factor for the development of HF (HR: 1.25 95% CI: 1.13, 1.38 I2=87%). Results did not alter in significance on sensitivity analysis. There was minimal change in the significance of results on subgroup analyses stratified by location, design, included participants, method of assessment of depression and HF, prevalence of depression, incidence of HF and follow-up duration. Meta-regression analysis based on moderators diabetes mellitus, hypertension, current smoking and mean body mass index did not reveal significant results. GRADE assessment indicated that certainty of evidence was “very low”.

Very low quality of evidence suggests that there may be an association between depression and development of HF. Appropriate screening should be undertaken for early recognition of HF in patients with depression.

Registration No: (PROSPERO CRD42024573423).

Figures