Mediating effects of depressive and heart failure symptoms in their associations with quality of life in patients with heart failure

Abstract

Aim

To test the bidirectional mediating relationships among heart failure (HF) symptoms, depressive symptoms, and health-related quality of life (HRQoL) in patients with HF, controlling for age, functional status, comorbidity, self-care, and self-care self-efficacy.

Background

Patients with HF often have poor HRQoL. HF and depressive symptoms affect HRQoL, suggesting their potential mediating roles. However, these associations have not been investigated in patients with HF.

Methods

In this cross-sectional, correlational study, data on all study variables and sociodemographic and clinical characteristics were collected from 54 patients with HF (mean age = 67.5). The PROCESS macro for SPSS was used to address the purpose.

Results

More severe HF symptoms (p < 0.001) were significantly associated with more severe depressive symptoms, and both symptoms (p = 0.007 and p = 0.005, respectively) were significantly associated with poorer HRQoL (F = 7.947, R² = 0.619, p < 0.001), after controlling for covariates (indirect effect: effect = 0.309, bootstrap 95 % CI = 0.045–0.648). By contrast, HF symptoms did not mediate the relationship between depressive symptoms and HRQoL.

Conclusions

Both depressive and HF symptoms play critical roles in the HRQoL; however, their mechanisms differ. Depressive symptoms were only directly associated, whereas HF symptoms were directly and indirectly associated with HRQoL. Healthcare providers and researchers should prioritize improving HF symptoms and addressing depressive symptoms to improve HRQoL in patients with HF.