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Manifestations of Depression in Patients Receiving Goal-directed Treatment for Pulmonary Arterial Hypertension

John Swisher


Regina Overton-Barnes

S Clay

C Collins

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Conference: 2018 PHA International PH Conference & Scientific Sessions

Release Date: 06.28.2018

Presentation Type: Abstracts

File Download: Conference 2018_1048

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2018 International PH Conference and Scientific SeAbstract presented at the 2018 International PH Conference and Scientific Sessions in Orlando, Fla., June 28-July 1, 2018.

Purpose

The objective of this analysis was to evaluate the prevalence, severity and specific manifestations of depression in patients receiving goal-directed therapy for pulmonary arterial hypertension.

Background

Pulmonary arterial hypertension (PAH) is a chronic debilitating disease resulting from well-described pathophysiologic changes in pulmonary arteries that increase pulmonary vascular resistance and lead to right ventricular failure. The disease is associated with impaired activity tolerance, social limitations, and financial burdens that decrease quality of life and provoke anxiety and depression. The prevalence of moderate to severe depression has been estimated as high as 26% in patients with PAH. The current analysis evaluates the prevalence and phenotypic manifestations of depression in treated patients meeting targeted PAH therapy goals compared to a group not achieving outcome goals.

Methods

This is a retrospective analysis of clinical data collected from a cohort of PAH patients seen in a community pulmonary hypertension center between August 2016 and May 2017. Key data evaluated included patient demographics, 6 minute walk (MW) distance, WHO functional class (FC) and PHQ-9 depression survey responses. Only patients with a confirmed hemodynamic diagnosis of WHO Group I PAH were included. Further, patients were only included if they had completed all of the study parameters on a single visit during the study period, and they had been on a treatment regimen for PAH for at least 6 months. Targets for goal-directed therapy included a 6 MW distance of at least 400 meters and WHO FC I or 2 symptoms determined by a standardized questionnaire.

Results

36 patients met all inclusion criteria for this analysis. Based on PHQ-9 scoring, 30.5% of the patients had no manifestations of depression, 30.5% had minimal depression, 30.5% had mild depression, and 8.5% had moderate depression. There was no relationship between 6 MW distance and severity of depression. There was a notable shift in functional class distribution with decreasing percentages of FC 1 and 2 patients and increasing percentages of FC 3 and 4 in patients with higher depression scores. Fourteen patients (39%) were meeting goal-directed therapy targets; they were compared with 22 patients (61%) not meeting at least one therapy target. There were no significant age or gender differences between these two groups. Median PHQ-9 depression scores were significantly lower in the group meeting PAH treatment goals (p=0.03). Significantly fewer patients in the group meeting treatment goals reported “having little interest or pleasure in doing things” and “feeling down, depressed, or hopeless” (p<0.05). Frequency and severity of all other manifestations of depression on the PHQ-9 questionnaire were lower in the group meeting treatment goals although did not meet statistical significance.

Conclusions

Manifestations of depression are less frequent and severe when targeted PAH therapy regimens are effective in achieving treatment goals. Monitoring symptoms of depression in patients undergoing treatment for PAH will identify those that may benefit from adjunctive treatment for depression.