Depressive Symptoms and 6-Year KCCQ Health Status in Chronic Heart Failure

BACKGROUND: Long-term disease-specific health status trajectories in ambulatory chronic heart failure (HF) are incompletely characterized, and the contribution of depressive symptoms remains uncertain. OBJECTIVES: The objectives of the study was to characterize 6-year Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS) trajectories and distinguish persistent and visit-specific depressive symptom associations with health status. METHODS: In the prospective Cognition.Matters-HF cohort, 148 patients with HF underwent assessments at baseline and 6, 12, 36, and 69 months. Linear mixed-effects models estimated KCCQ-OSS trajectories and prespecified correlates. Patient Health Questionnaire-9 (PHQ-9) scores were decomposed into between-person and within-person components. Sensitivity analyses addressed missingness, and exploratory lagged analyses assessed whether recent PHQ-9 worsening predicted subsequent KCCQ deterioration or adverse clinical events. RESULTS: KCCQ-OSS remained stable over 69 months (78.0-76.6; change: -1.4; 95% CI: -4.6 to 1.8; P for time = 0.065), despite substantial individual variation. Higher between-person PHQ-9 burden (β: -3.44 per point; 95% CI: -4.00 to -2.88; P < 0.001) and within-person PHQ-9 worsening (β: -1.80; 95% CI: -2.50 to -1.11; P < 0.001) were associated with lower concurrent KCCQ-OSS. Recent PHQ-9 worsening did not predict subsequent KCCQ-OSS, a ≥5-point KCCQ decline, or all-cause death/HF hospitalization. NYHA functional class and 6-min walking distance, but not N-terminal pro-B-type natriuretic peptide, left ventricular ejection fraction, or executive function, were independently associated with KCCQ-OSS. CONCLUSIONS: In ambulatory chronic HF, average KCCQ-based health status remained stable over 6 years despite substantial individual variation. Depressive symptoms were strongly associated with concurrent health status, but recent worsening did not predict subsequent KCCQ deterioration or adverse clinical events.