TitleDepressive symptoms, cardiovascular disease severity, and functional status in older adults with coronary heart disease: the heart and soul study.
Publication TypeJournal Article
Year of Publication2015
AuthorsSin, NL, Yaffe, K, Whooley, MA
JournalJ Am Geriatr Soc
Date Published2015 Jan
KeywordsActivities of Daily Living, Aged, Coronary Disease, Depression, Echocardiography, Exercise Test, Female, Humans, Longitudinal Studies, Male, Prospective Studies, Risk Factors, San Francisco, Severity of Illness Index, Surveys and Questionnaires

<p><b>OBJECTIVES: </b>To compare the contributions of depressive symptoms and cardiovascular disease (CVD) severity to functional decline in individuals with coronary heart disease.</p><p><b>DESIGN: </b>Longitudinal.</p><p><b>SETTING: </b>Twelve outpatient clinics in the San Francisco Bay area.</p><p><b>PARTICIPANTS: </b>Older adults (N = 960; mean age 67) with stable coronary heart disease recruited between September 2000 and December 2002.</p><p><b>MEASUREMENTS: </b>At baseline, depressive symptoms and angina pectoris were assessed according to self-report, and left ventricular ejection fraction (LVEF) and exercise capacity were evaluated using echocardiography and exercise treadmill testing. Difficulty performing activities of daily living and instrumental activities of daily living was assessed at baseline and annually for the next 5 years. Covariates included demographic characteristics, comorbid conditions, cognitive function, social support, and health behaviors. Five years later, 658 participants returned for follow-up assessments.</p><p><b>RESULTS: </b>Higher baseline depressive symptoms predicted greater risk of functional decline over 5 years, whereas higher baseline exercise capacity was associated with lower risk of functional decline. In 658 participants who returned for follow-up, 5-year changes in depressive symptoms and exercise capacity were associated with 5-year changes in functional status. Angina pectoris frequency and LVEF were not associated with functional decline or change in functional status, after adjusting for covariates and other predictors.</p><p><b>CONCLUSION: </b>In older adults with coronary heart disease, depressive symptoms and lower exercise capacity predicted functional decline over 5 years. In contrast, other traditional measures of CVD severity (LVEF and angina pectoris) were not independently predictive of subsequent functional status. These findings suggest that efforts to ameliorate depressive symptoms may be as important as treating CVD severity to enhance functional status.</p>

Alternate JournalJ Am Geriatr Soc
PubMed ID25597554
PubMed Central IDPMC4299945
Grant ListR01 HL079235 / HL / NHLBI NIH HHS / United States
K24AG031155 / AG / NIA NIH HHS / United States
T32 AG000212 / AG / NIA NIH HHS / United States
K24 AG031155 / AG / NIA NIH HHS / United States
T32AG000212-20 / AG / NIA NIH HHS / United States
R01HL-079235 / HL / NHLBI NIH HHS / United States
P30 AG044281 / AG / NIA NIH HHS / United States