Rumsfeld John S, Havranek Edward, Masoudi Frederick A, Peterson Eric D, Jones Philip, Tooley Joseph F, Krumholz Harlan M, Spertus John A
Cardiology (111B), Denver VA Medical Center, Denver, Colorado 80220, USA.
J Am Coll Cardiol. 2003 Nov 19;42(10):1811-7. doi: 10.1016/j.jacc.2003.07.013.
The purpose of this study was to assess whether depressive symptoms are independently associated with changes in heart failure (HF)-specific health status.
Depression is common in patients with HF, but the impact of depressive symptoms on the health status of these patients over time is unknown.
We conducted a multicenter prospective cohort study of outpatients with HF. Data from 460 patients who completed a baseline Medical Outcomes Study-Depression Questionnaire and both a baseline and follow-up (6 +/- 2 weeks) Kansas City Cardiomyopathy Questionnaire (KCCQ) were analyzed. The KCCQ measures HF-specific health status, including symptoms, physical and social function, and quality of life. Multivariable regression was used to evaluate depressive symptoms as a predictor of change in KCCQ scores, adjusting for baseline KCCQ scores and other patient variables. The primary outcome was change in KCCQ summary scores (range 0 to 100; higher scores indicate better health status; 5 points is a clinically meaningful change).
Approximately 30% (139/460) of the patients had significant depressive symptoms at baseline. Depressed patients had markedly lower baseline KCCQ summary scores (beta = -19.6; p < 0.001). After adjustment for potential confounders, depressed patients were at risk for significant worsening of their HF symptoms, physical and social function, and quality of life (average change in KCCQ summary score = -7.1 points; p < 0.001). Depressive symptoms were the strongest predictor of decline in health status in the multivariable models.
Depressive symptoms are a strong predictor of short-term worsening of HF-specific health status. The recognition and treatment of depression may be an important component of HF care.
本研究旨在评估抑郁症状是否与心力衰竭（HF）特异性健康状况的变化独立相关。
抑郁症在HF患者中很常见，但抑郁症状对这些患者健康状况随时间的影响尚不清楚。
我们对HF门诊患者进行了一项多中心前瞻性队列研究。分析了460名完成基线医学结局研究-抑郁问卷以及基线和随访（6±2周）堪萨斯城心肌病问卷（KCCQ）的患者的数据。KCCQ测量HF特异性健康状况，包括症状、身体和社会功能以及生活质量。多变量回归用于评估抑郁症状作为KCCQ评分变化的预测因素，并对基线KCCQ评分和其他患者变量进行调整。主要结局是KCCQ总分的变化（范围为0至100；分数越高表明健康状况越好；5分是具有临床意义的变化）。
约30%（139/460）的患者在基线时有明显的抑郁症状。抑郁患者的基线KCCQ总分明显较低（β=-19.6；p<0.001）。在对潜在混杂因素进行调整后，抑郁患者有HF症状、身体和社会功能以及生活质量显著恶化的风险（KCCQ总分平均变化=-7.1分；p<0.001）。在多变量模型中，抑郁症状是健康状况下降的最强预测因素。
抑郁症状是HF特异性健康状况短期恶化的有力预测因素。识别和治疗抑郁症可能是HF护理的重要组成部分。
