Prevalence of Depression in Adult Saudi Patients with Heart Failure

King Abdulaziz Medical City

Dalia Ali SN, M B Bdeir MD, Tara conboy NS

g yCardiovascular diseases management program

Saudi Heart Association22nd Annual Symposium

Disclosures: None

Cardiovascular Disease ManagementCardiovascular Disease Management Program In KAMC

E t bli h d i 2000♥ Established in 2000.♥ 4 programs: Heart failure Heart failure Atherosclerosis Cardiac diabetes educationCardiac diabetes education Life style modification

Nurse led, cardiologist supervised, and target oriented program.

BackgroundBackground

Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, f li f ilt l lf th di t b d lfeelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration.

WHO2011

BackgroundBackground

♥ Depression can become chronic , lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilitiestake care of his or her everyday responsibilities

♥ Most studies of depression in patients with heart p pfailure have been carried out in developed countries and evaluated hospitalized patients

J Am Coll Cardiol, 2004

Prevalence of Depression in Patients with HF

♥ Hospitalized patients: 13% to 77.5%

♥ Out-patient (small studies): 13% to 42%and have not adequately accounted for thehave not adequately accounted for the impact of age, race, or gender

J Am Coll Cardiol, 2004

ObjectivesObjectives

♥ To study the prevalence of depression in adult Saudi population with HFadu t Saud popu at o t

♥ To identify factors that may affect♥ To identify factors that may affect prevalence of depression.

M th dMethods

♥ A retrospective study of a prospectivelycollected data Included the first 148 heart failurepatients who completed the patient healthquestionnaire ( PHQ9)

Methods♥ Inclusion criteriaMethods

■ All patient have history of heart failure with documented ejection fraction of ≤ 40%documented ejection fraction of ≤ 40%

■ All patients had at least one visit to the heart fail re clinic from Ma 2010 to October 2010failure clinic from May 2010 to October 2010.

Methods

♥

Methods

♥ Exclusion criteria

■ Patients known to have clinical depression or treated for depression prior to enrollment in the programprogram

Methods■ The questionnaire was carried out by nurses through confidential diagnostic interviewconfidential diagnostic interview

■ Medical and demographic data were obtained from the l t i t i d telectronic computerized system

■ Depression assessment was carried out via a pvalidated Arabic translated version of the Patient Health Questionnaire (PHQ)

PHQPHQ

■ PHQ-9 is a nine item depression scale

■ Powerful tool for diagnosing depression, in addition to, selection and monitoring of anti-depression treatmenttreatment

.

Dietrich AJ, Oxman TE, Burns MR, et al; Application of a depression management office system in community practice: a demonstration. J Am Board Fam Pract. 2003 Mar-Apr;16(2):107-14

PHQ

■ Validity of PHQ has been assessed against i d d t t t d t l h lth

PHQ

an independent structured mental health professional interview. PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88%a sensitivity of 88% and a specificity of 88% for major depression.

■ PHQ is easy to administer, accessible, free and is accepted culturally in our patientand is accepted culturally in our patient population

Kroenke K, Spitzer RL, Williams JB; The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13

PHQQ

B li Ch t i tiBaseline Characteristics

Characteristics Total (n=148)Characteristics Total (n=148)

Mean Age (years )Mean Age (years ) 61±11

Male Gender Male Gender 72%

DM 68%

HTN 68%

BMI>30 50%

Dyslipidemia 87%

ResultsResults

72% 107males

28%

41females

28%

Males FemalesMales Females

Total patients: 148 (72% males 28% females )Total patients: 148 (72% males, 28% females )

PHQ resultsPHQ results

68%

21%6%3%2%

No depression Mild Moderate Moderate to severe Severe

Results

Total 148 patients

F l M lFemales54% depressed

Males24% depressed

Depression With Age

50%

Depression With Age

36%35%40%45%

26%

20%25%30%35%

10%15%20%

0%5%

Age ≤60 Age>60g g

Prevalence Of Comorbidities In none Depressed Patients

100.0%

p

70.0%80.0%90.0%

40.0%50.0%60.0%

40% 37% 45%24%10.0%

20.0%30.0%

%

0.0%10.0%

DM HTN Dyslipidemia Obesity

Prevalence Of Comorbidities In Depressed Patients

100.0%

p

70.0%80.0%90.0%

85% 77%88%40.0%

50.0%60.0%

77% 69%

10.0%20.0%30.0%

%

0.0%10.0%

DM HTN Dyslipidemia Obesity

ResultsResults

■ 32 % of the total patients experiencep pdifferent degrees of depression

■ Depressed patients tended to be youngery g

■ Women were more likely (54%) to y ( )be depressed

Results■ Depression is more common in patients with other

multiple co morbidities like obesity hypertension

Results

multiple co morbidities like obesity , hypertension and DM.

OR

■ Existence of multiple comorbidities in patient with HF make them more likely to have some degree of depressionp

ConclusionConclusion

♥ Depression is prevalent in adult Saudi patients with HF

♥ It is considerably higher in certain groups such as females , young age and patients with other multiple co morbidities like obesity h t i d DM, hypertension and DM.

Thank YouThank You

• Depression has a huge impact on individuals andDepression has a huge impact on individuals and society; with a lifetime prevalence of over 15%, depression will be the second leading illness in the

ld b 2020 j t d b th W ld H lthworld by 2020 as projected by the World Health Organization