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In Reply: We agree with Dr Gandjour that the association between depressive symptoms and disease-specific health status was expected.¹ However, prior studies had not simultaneously compared the contributions of depressive symptoms and cardiac function with disease-specific health status. Our study's novel finding was that while depressive symptoms were strongly associated with cardiac-specific health status, 2 traditional measures of cardiac function (ie, ejection fraction and ischemia) were not. Indeed, depressive symptoms were as strongly associated with cardiac-specific health status as was exercise capacity, one of the primary variables used to validate the Seattle Angina Questionnaire.²

We disagree with Gandjour's suggestion that the association (or lack of association) between cardiac function and current quality of life is irrelevant. Current health status (including HRQOL) is of great importance to patients and independently predicts cardiovascular events and mortality.³ Treatment of depression leads to improved health status and may even result in improved cardiac outcomes.^4-5 . . . [Full Text of this Article]

Bernice Ruo, MD; Mary Whooley, MD
Veterans Affairs Medical Center and University of California
San Francisco

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Depression and Health-Related Quality of Life
Afschin Gandjour
JAMA. 2003;290(18):2404.
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