The Impact of Depression on Outcomes in Patients with Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial

Background It remains unclear why depression is associated with adverse outcomes in heart failure (HF) patients. We examine the relationship between depression and clinical outcomes among patients with HF and reduced ejection fraction (HFrEF) managed with guideline directed medical therapy (GDMT). Methods Using the GUIDE-IT trial, 894 patients with HFrEF were stratified according to a history of depression, and Cox proportional hazards regression modeling was used to examine the association with outcomes. Results 140 patients (16%) of the overall cohort had depression. They tended to be female (29% vs. 46%; P 0.05, all). After adjustment, depression was associated with all-cause hospitalizations [HR 1.42 (CI: 1.11-1.81), P Conclusion Depression impacts clinical outcomes in HF regardless of GDMT intensity and NT-proBNP levels. This underscores the need for a focus on mental health in parallel to achievement of optimal GDMT in these patients. Trial registration NCT01685840, https://clinicaltrials.gov/ct2/show/NCT01685840.