Depressive Symptoms and Incident Hospitalization for Heart Failure: Findings From the REGARDS Study

BACKGROUND: Depressive symptoms are risk factors for several forms of cardiovascular disease including coronary heart disease (CHD). However, it is unclear whether depressive symptoms are associated with incident heart failure (HF), including hospitalization for HF overall or by subtype: HF with preserved (HFpEF) or reduced ejection fraction (HFrEF). METHODS AND RESULTS: Among 26 268 HF‐free participants in the REGARDS (Reasons for Geographic And Racial Differences in Stroke) study, a prospective biracial cohort of US community‐dwelling adults ≥45 years, baseline depressive symptoms were defined as a score ≥4 on the 4‐item Center for Epidemiologic Studies Depression scale. Incident HF hospitalizations were expert‐adjudicated and categorized as HFpEF (EF ≥50%) and HFrEF, including mid‐range EF (EF<50%). Over a median of 9.2 [IQR 6.2–10.9] years of follow‐up, there were 872 incident HF hospitalizations, 526 among those without CHD and 334 among those with CHD. The age‐adjusted HF hospitalization incidence rates per 1000 person‐years were 4.9 (95% CI 4.0–5.9) for participants with depressive symptoms versus 3.2 (95% CI 3.0–3.5) for those without depressive symptoms (P<0.001). For overall HF, the elevated risk became attenuated after controlling for covariates. When HFpEF was assessed separately, depressive symptoms were associated with incident hospitalization after controlling for all covariates (hazard ratio [HR] 1.48, 95% CI 1.00–2.18) among those without baseline CHD. In contrast, depressive symptoms were not associated with incident HFrEF hospitalizations. CONCLUSIONS: Among individuals free of CHD at baseline, depressive symptoms were associated with incident hospitalization for HFpEF, but not for HFrEF, or among those with baseline CHD.