Quality of Life in Heart Failure Patients Differs Based on the Interaction Between Depression and Cognitive Function: A Pilot Study

Heart failure (HF) is a chronic condition and one of the leading causes of hospitalization. It is critical to recognize risk factors impacting quality of life (QOL) in these patients. Both depression and cognitive dysfunction are prevalent in HF, and each independently have been shown to negatively impact QOL. While a relationship between depression and cognitive function is established, how depression and cognitive function interact to predict QOL in patients with HF is unknown. Further, prior studies have typically used full neuropsychological batteries used to assess cognition, which are time consuming and expensive to conduct in the context of routine outpatient appointments. We hypothesized that cognitive dysfunction and depression would lead to reduced QOL as measured using gold standard brief screening tools. As a part of a pilot program to incorporate cognitive and behavioral health screening into regular outpatient treatment, 23 patients completed the Montreal Cognitive Assessment (MoCA), the Kansas City Cardiomyopathy Questionnaire (KCCQ-12), the Patient Health Questionnaire (PHQ-2), and provided demographic and medical information during a regular medical visit. Participants with and without symptoms of depression were compared on the subscales of the KCCQ-12 using a multivariate analysis of variance controlling for age and severity of HF as measured by New York Heart Class (NYHC). MANCOVA revealed that the interaction of PHQ-2 and MoCA score was related to decreased QOL (Pillai's Trace = 0.48, p = 0.047), adjusting for age and NYHC. Those endorsing symptoms of depression and lower cognitive function scored significantly worse on the Symptoms Frequency subscale of the KCCQ-12 (F = 9.55, p = 0.007) as compared to those with greater cognitive function or without symptoms of depression. A main effect of depression was also revealed (Pillai's Trace = 0.38, p = 0.027), such that those with depression symptomatology scored significantly worse on Symptom Frequency than those without (F = 11.27, p = 0.004), when controlling for age, NYHC and cognitive function. Our findings are consistent with research suggesting patients with HF who experience depressive symptoms or reduced cognitive function have decreased QOL regardless of age or severity of their illness. This are the first findings demonstrating an interaction effect using brief screening measures that can easily be incorporated into outpatient treatment. Further study is necessary to explore therapeutic strategies for patients with comorbid cognitive dysfunction and depression. This data demonstrates the need for routine cognitive and depressive screenings in outpatient settings to facilitate early intervention to improve QOL in patients with HF.