A longitudinal study of depressive symptom trajectories and risk factors in congestive heart failure

Background: Depression is prevalent among patients with congestive heart failure (CHF) and is associated with increased mortality and healthcare utilization. However, most research has focused on high-income countries, leaving a gap in knowledge regarding the relationship between depression and CHF in low-to-middle-income countries (LMICs). This study aimed to delineate depressive symptom trajectories and identify potential risk factors for poor outcomes among CHF patients. Methods: Longitudinal data from 783 patients with CHF from public hospitals in Karachi, Pakistan was analyzed. Depressive symptom severity was assessed using the Beck Depression Inventory (BDI). Baseline and 6-month follow-up BDI scores were clustered through Gaussian Mixture Modeling to identify distinct depressive symptom subgroups and extract trajectory labels. Further, a random forest algorithm was utilized to determine baseline demographic, clinical, and behavioral predictors for each trajectory. Results: Four depressive symptom trajectories were identified: 'good prognosis,' 'remitting course,' 'clinical worsening,' and 'persistent course.' Risk factors associated with persistent depressive symptoms included lower quality of life and the New York Heart Association (NYHA) class 3 classification of CHF. Protective factors linked to a good prognosis included less disability and a non-NYHA class 3 classification of CHF. Conclusions: By identifying key characteristics of patients at heightened risk of depression, clinicians can be aware of risk factors and better identify patients who may need greater monitoring and appropriate follow-up care. Keywords: congestive heart failure, depressive symptom trajectories, low-to-middle-income countries, risk factors, protective factors, longitudinal study.