Sullivan Martin J, Wood Laura, Terry Jennifer, Brantley Jeff, Charles Ann, McGee Vicky, Johnson Diane, Krucoff Mitchell W, Rosenberg Beth, Bosworth Hayden B, Adams Kirkwood, Cuffe Michael S
Institute for Health and Wellness, Chapel Hill, NC, USA.
Am Heart J. 2009 Jan;157(1):84-90. doi: 10.1016/j.ahj.2008.08.033.
The Support, Education, and Research in Chronic Heart Failure (SEARCH) study was designed to assess the impact of a mindfulness-based psychoeducational intervention on clinical outcomes, depression, and quality of life in patients with chronic heart failure (CHF). Although research has shown that psychosocial factors including depression are important risk factors for adverse events in patients with CHF, no large clinical trials have investigated the efficacy of psychosocial interventions to reduce these factors in this population.
This was a prospective cohort study of 208 adults with left ventricular ejection fraction < or =40% and CHF geographically assigned to treatment or control groups with follow-up at 3, 6, and 12 months. Treatment groups met weekly for 8 consecutive weeks for training in mindfulness meditation, coping skills, and support group discussion.
Subjects had a mean age of 61 years, left ventricular ejection fraction 26%, and median New York Heart Association class II. The majority were treated with angiotensin-converting enzyme inhibitors (80%) and beta-blockers (86%). At baseline, patients in the treatment group had more severe CHF with higher New York Heart Association class (P = .0209) and more severe psychological distress (Center of Epidemiology - Depression, Profile of Mood States; P < .05). When compared with controls, treatment resulted in lower anxiety (Profile of Mood States, P = .003), depression (Center of Epidemiology - Depression, P = .05), improved symptoms (Kansas City Cardiomyopathy Questionnaire symptom scale, P = .033) and clinical scores (Kansas City Cardiomyopathy Questionnaire clinical score, P = .024) over time. There were no treatment effects on death/rehospitalization at 1 year.
An 8-week mindfulness-based psychoeducational intervention reduced anxiety and depression; this effect was attenuated at 1 year. Importantly, the intervention led to significantly better symptoms of CHF at 12 months compared to control subjects. Our results suggest that interventions of this type might have a role in optimal therapy for CHF.
慢性心力衰竭支持、教育与研究（SEARCH）研究旨在评估基于正念的心理教育干预对慢性心力衰竭（CHF）患者临床结局、抑郁和生活质量的影响。尽管研究表明，包括抑郁在内的社会心理因素是CHF患者不良事件的重要危险因素，但尚无大型临床试验研究社会心理干预在该人群中减少这些因素的疗效。
这是一项对208名左心室射血分数≤40%且患有CHF的成年人进行的前瞻性队列研究，根据地理位置将其分为治疗组或对照组，并在3个月、6个月和12个月时进行随访。治疗组连续8周每周会面一次，进行正念冥想、应对技巧和支持小组讨论的培训。
受试者的平均年龄为61岁，左心室射血分数为26%，纽约心脏协会心功能分级中位数为II级。大多数患者接受了血管紧张素转换酶抑制剂（80%）和β受体阻滞剂（86%）治疗。基线时，治疗组患者的CHF更严重，纽约心脏协会心功能分级更高（P = 0.0209），心理困扰更严重（流行病学中心抑郁量表、情绪状态剖面图；P < 0.05）。与对照组相比，随着时间的推移，治疗导致焦虑程度降低（情绪状态剖面图，P = 0.003）、抑郁程度降低（流行病学中心抑郁量表，P = 0.05）、症状改善（堪萨斯城心肌病问卷症状量表，P = 0.033）和临床评分改善（堪萨斯城心肌病问卷临床评分，P = 0.024）。1年时，治疗对死亡/再住院率没有影响。
为期8周的基于正念的心理教育干预可减轻焦虑和抑郁；这种效果在1年后减弱。重要的是，与对照组相比，该干预在12个月时使CHF症状明显改善。我们的结果表明，这类干预可能在CHF的最佳治疗中发挥作用。
