Prognostic Implication of Earthquake‐Related Loss and Depressive Symptoms in Patients With Heart Failure Following the 2008 Earthquake in Sichuan

Abstract

BACKGROUND: Earthquake exposure is associated with adverse consequences for cardiovascular disease. However, in the context of depressive symptoms, the prognostic significance of heart failure (HF) related to earthquake-related loss has not been characterized before. HYPOTHESIS: To determine the prognostic impact of earthquake-related loss on event-free survival in patients with HF, with depression as a modifying factor. METHODS: Depressive symptoms were assessed by using the Zung Self-Rating Depression Scale in 404 HF patients who were followed up for 2 years after the earthquake to collect data on mortality and readmission. The Kaplan-Meier method was used to compare event-free survival between patients with and without earthquake-related loss. Cox proportional hazard regression modeling was used to examine the predicted outcomes for baseline variables. RESULTS: The proportion of patients with moderate/severe depressive symptoms among the HF patients with earthquake-related loss is much higher than their counterparts (27.038% vs 17.84%, P = 0.039). Heart failure patients without loss experienced longer event-free survival than patients with loss (P = 0.002), especially among patients without depressive symptoms (P = 0.003). Meanwhile, in a Cox proportional hazard regression model, the event-free survival was associated with earthquake-related loss, left ventricular ejection fraction, depressive symptoms, and chronic obstructive pulmonary disease or asthma. CONCLUSIONS: Heart failure patients without earthquake-related loss experienced longer event-free survival than did HF patients with severe loss. Earthquake-related loss was a predictor of poor outcomes in HF patients, particularly in patients without depression.