Psychosocial Patterns and Prognosis in Patients With Heart Failure

Studies suggest that depressive symptoms may be associated with a worse prognosis and higher costs of care in patients with chronic heart failure in some populations, but such data in a French population are missing. On the other hand, little is known of the impact of other psychosocial dysfunction whereas the pathophysiology of this association remains hypothetical.

Main objective: to confirm the impact of depressive symptoms on cardiovascular death in ambulatory heart failure patients

Other objectives:

• to study the impact of depressive symptoms on sudden death, non cardiovascular death, and hospitalization rates;
• to study the role of other psychosocial patterns or personality traits such as anxiety disorders, locus of control, perceived social support, anger, hopelessness, optimism and type D personality in cardiovascular and total mortality;
• to study the interaction with patient behaviors (drug compliance, addictions);
• to explore some pathophysiological pathways (chronic inflammation and chronic loss of myocytes),
• and to evaluate the impact of psychosocial distress on health care costs. Design: multicenter observational study with a minimum of 2 year follow up Population: 700 ambulatory patients, aged above 18 y.o., with acute heart failure within the last 24 months

Methodology:

• psychosocial patterns and personality traits are assessed using validated self-administered questionnaire; use of the Beck Depression Index in this population is validated against the Montgomery & Asberg Depression Rating Scale evaluation
• cardiac condition is evaluated at pre-defined time period by B-natriuretic peptide levels, echocardiography and 6'-walk test

End-point criteria:

• primary : rate of cardiovascular death
• secondary : rate of total mortality and sudden death, rate of rehospitalization for heart failure and for any cause, total and specific health care costs.

Inclusion criteria

• age above 18,
• acute heart failure within the last 24 months
• stable cardiovascular condition for at least 2 weeks
• non hospitalized, non institutionalized patient,
• french speaking and reading,

Exclusion criteria

• Non inclusion criteria :
• curable cardiomyopathy, cardiomyopathies associated with systemic illnesses (Lupus...), neurodegenerative or pulmonary illnesses, or hypertrophic/restrictive cardiomyopathy
• unstable cardiovascular condition
• heart transplant and hemodialysis patient