CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
Circ Heart Fail. 2010 Mar;3(2):261-7. doi: 10.1161/CIRCHEARTFAILURE.109.871483. Epub 2010 Jan 13.
Depression, anxiety, and type D ("distressed") personality (tendency to experience negative emotions paired with social inhibition) have been associated with poor prognosis in coronary heart disease, but little is known about their role in chronic heart failure. Therefore, we investigated whether these indicators of psychological distress are associated with mortality in chronic heart failure.
Consecutive outpatients with chronic heart failure (n=641; 74.3% men; mean age, 66.6+/-10.0 years) filled out a 4-item questionnaire to assess mixed symptoms of anxiety and depression and the 14-item type D scale. End points were defined as all-cause and cardiac mortality. After a mean follow-up of 37.6+/-15.6 months, 123 deaths (76 due to cardiac cause) were recorded. Cumulative hazard functions for elevated anxiety/depression symptoms differed marginally for all-cause (P=0.06), but not cardiac, mortality (P=0.43); type D personality was associated with neither all-cause mortality (P=0.63) nor cardiac mortality (P=0.87). In multivariable analyses, neither elevated anxiety/depression symptoms nor type D personality was associated with all-cause mortality (hazard ratio [HR]=1.18; 95% CI, 0.76 to 1.84; P=0.45 and HR=1.09; 95% CI, 0.67 to 1.77; P=0.73, respectively) or cardiac mortality (HR=1.13; 95% CI, 0.63 to 2.04; P=0.65 and HR=1.16; 95% CI, 0.62 to 2.18; P=0.67). In secondary analyses, a 1-point increase in anxiety/depression (range, 0 to 16) was associated with an 8% increase in risk for all-cause mortality (HR=1.08; 95% CI, 1.01 to 1.15; P=0.02).
Neither elevated anxiety/depression symptoms nor type D personality was associated with an increased risk for all-cause or cardiac mortality. Future studies with adequate power and a longer follow-up duration are needed to further elucidate the role of psychological distress in chronic heart failure.
抑郁、焦虑和 D 型人格（倾向于体验负面情绪并伴有社交抑制）与冠心病预后不良有关，但关于其在慢性心力衰竭中的作用知之甚少。因此，我们研究了这些心理困扰指标是否与慢性心力衰竭患者的死亡率相关。
连续入选慢性心力衰竭门诊患者（n=641；74.3%为男性；平均年龄 66.6+/-10.0 岁）填写 4 项问卷评估焦虑和抑郁混合症状和 14 项 D 型人格量表。终点定义为全因和心脏死亡率。在平均 37.6+/-15.6 个月的随访后，记录了 123 例死亡（76 例死于心脏原因）。升高的焦虑/抑郁症状的累积危险函数在全因（P=0.06），但不是心脏（P=0.43）死亡率方面存在差异；D 型人格与全因死亡率（P=0.63）或心脏死亡率（P=0.87）均无关。多变量分析中，升高的焦虑/抑郁症状或 D 型人格均与全因死亡率（危险比[HR]=1.18；95%CI，0.76 至 1.84；P=0.45 和 HR=1.09；95%CI，0.67 至 1.77；P=0.73）或心脏死亡率（HR=1.13；95%CI，0.63 至 2.04；P=0.65 和 HR=1.16；95%CI，0.62 至 2.18；P=0.67）无关。在二次分析中，焦虑/抑郁评分（范围为 0 至 16）增加 1 分，全因死亡率风险增加 8%（HR=1.08；95%CI，1.01 至 1.15；P=0.02）。
升高的焦虑/抑郁症状或 D 型人格与全因或心脏死亡率的增加无关。需要进一步阐明心理困扰在慢性心力衰竭中的作用，未来的研究需要有足够的效力和更长的随访时间。
