# Assessment the Level of Comorbid Depression, Quality of Life and Associated Factors Among Patients with Heart Failure: An Outpatient-Based Study

## TL;DR

This study found that nearly half of heart failure patients in Bursa, Türkiye, have moderate or severe depression, which is linked to lower quality of life.

## Contribution

The study provides new data on depression and quality of life in heart failure outpatients in Türkiye, identifying specific contributing factors.

## Key findings

- Nearly half of the patients had moderate or severe depression, which correlated with lower quality of life.
- Longer duration of heart failure, more hospitalizations, and NYHA class IV were significantly associated with higher depression and lower quality of life.
- Depression (BDI) explained 51% of the variation in quality of life (MLHFQ) scores.

## Abstract

Background: Heart failure (HF) affects not only the cardiovascular system but also mental health. The majority of patients with HF experience symptoms of mental disorders, such as depression, which are proportionally related to the severity of HF. This results in a significant comorbidity of HF, which might be associated with poor clinical outcomes, including decreased health-related quality of life (HRQOL). In Türkiye, data concerning the extent of this complication among outpatients with HF are limited. Therefore, the aim of this study was to assess the prevalence of depression in outpatients with HF and consequently the HRQOL; the secondary aim was to identify the related factors contributing to the incidence of depression and HRQOL in patients with HF in Bursa, Türkiye. Methods: An outpatient, descriptive, observational, cross-sectional study was conducted in a cardiology outpatient clinic in Bursa Province, Türkiye, between September and December 2022. The study was conducted via a validated questionnaire consisting of four sections. Depression was measured using the Beck Depression Inventory (BDI) scale, and the HRQOL of HF patients was evaluated using the Turkish version of the Minnesota Living with HF Questionnaire (MLHFQ). Simple linear regression and multiple linear regression analyses were used to determine the effects of variables. Limitations of the study include its design as a descriptive, observational, cross-sectional study from a single center that relies on self-reported data. Results: A total of 166 patients were enrolled, with a mean age of 64.96 ± 11.33 years. Nearly half of the participants had moderate or severe depression (33.1% and 15.7%, respectively). The mean MLHFQ score of the study participants was 54.15 ± 18.20. Patients suffering from severe depression had the lowest HRQOL (71.46 ± 12.4). There was a significant increase in depression level, and a decrease in HRQOL in patients with a duration of HF diagnosis of more than 3 years (p = 0.001), a number of HF hospitalizations (p = 0.001), and those diagnosed with NYHA class IV (p = 0.001). Multiple linear regression analysis revealed a significant relationship between the duration of HF disease, number of comorbidities, number of medications used, and BDI [(0.30 < r: 0.31/0.43/0.43 ≤ 0.70), respectively]. The simple linear regression analysis revealed that the BDI has positive and significant explanatory power for the MLHFQ (F: 168.29; R2: 0.51; t: 12.97; p < 0.001), and 51% of the change in the MLHFQ score is recorded by the BDI (R2: 0.51). Conclusions: The results of this study revealed that comorbid depression and HRQOL are closely related. This was observed in nearly half of the patients with HF, who had comorbid moderate and severe depression, which is associated with poor HRQOL. The factors associated with high depression and poor HRQOL were the duration of HF diagnosis of more than 3 years, an increased number of HF hospitalizations, polypharmacy, and NYHA class IV diagnoses.