Reactive Depression's Relationship to Rehospitalization in Heart Failure Patients
Repository Posting Date2017-07-17T15:58:00Z
Author(s)Walters, Mary Renee
Author DetailsMary Renee Walters, PhD, RN, CCRN, FNP-BC
Lead Author Sigma AffliationDelta
Level of EvidenceN/A
Purpose: To explore the effect of reactive depression on all-cause rehospitalization and all-cause mortality in NYHA Class III and IV patients during the 12 month following an index hospitalization for HF exacerbation. The study aims were: (a) describe the effect of depression, (b) explain the variance of depression, and (c) determine the moderator effect of depression on patient preparedness to manage complex HF home care all-cause rehospitalization and/or all-cause mortality in HF patients.
Methods: A Secondary Data Analysis of data obtained from a longitudinal study. Descriptive statistics, logistic regression, and multiple linear regression analyses with and with/out interaction effects were performed to address the study purpose and aims. Wagner's Chronic Care Model provided the theoretical framework that guided the study. Instruments included in this study: demographic sheet, the Center for Epidemiological Studies Depression Scale (CES-D), and the Dartmouth Primary Care Cooperative Information Project Chart System (measure social support), Income Adequacy rating scale, Preparedness for HF Home Care, and a medical record review for determining the comorbidities index score.
Results: Logistic regression, multiple regression, and moderator analysis were conducted to address the research questions. These analyses demonstrated that depression consistently has a significant relationship to rehospitalization. Depression as measured by CES-D score greater or equal than 16 has a significant relationship with all-cause rehospitalization p=.09 and all-cause rehospitalization and mortality p=.09. In this study, depression did not demonstrate a relationship with mortality alone. In addition, depression did not have an interaction effect between preparedness and all-cause rehospitalization and/or mortality.
Conclusion: A significant relationship was identified between depression and all cause readmission. The relationship between depression and the composite variable (all cause readmission and mortality) was also significant due to all cause readmission alone. This further supports the strength of the relationship between depression and rehospitalization. Screening for depression should be part of heart failure management. Management of depression may decrease rehospitalization in HF patients.