抑郁和心力衰竭疾病管理计划的有用性：来自 COACH（心力衰竭咨询和辅导效果评估协调研究）研究的见解。

Depression and the usefulness of a disease management program in heart failure: insights from the COACH (Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure) study.

机构信息

Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

出版信息

J Am Coll Cardiol. 2010 Apr 27;55(17):1837-43. doi: 10.1016/j.jacc.2009.11.082.

DOI:10.1016/j.jacc.2009.11.082

PMID:20413035

Abstract

OBJECTIVES

Our aim was to study the possible role of depressive symptoms in the effectiveness of a disease management program (DMP) in heart failure (HF) patients.

BACKGROUND

Disease management programs are recommended in current HF guidelines, but certain patient groups, such as those with depression, might be less responsive to such programs.

METHODS

From the data of a large multicenter study, in which we examined the effect of a DMP in HF patients, we investigated a potential interaction between depressive symptoms at baseline and the effect of such a program.

RESULTS

Of the 958 HF patients (37% female; age 71 +/- 11 years; New York Heart Association functional class II to IV), 377 (39%) reported depressive symptoms at baseline. During 18 months of follow-up, the primary end point (composite of all-cause mortality and HF readmission) occurred in 39% of the nondepressed patients and 42% of depressed patients. In the overall sample, there was no significant effect of DMP on the composite primary end point. The effect of the DMP was significantly different in nondepressed than in depressed HF patients. A significant effect modification by depressive symptoms was observed in evaluating the effect of the DMP on all-cause mortality and HF readmission (p = 0.03). In patients without depressive symptoms, DMP resulted in a trend for lower incidence of the primary end point (hazard ratio: 0.8, 95% confidence interval: 0.61 to 1.04), whereas the reverse was observed in patients with depressive symptoms (hazard ratio: 1.3, 95% confidence interval: 0.95 to 1.98).

CONCLUSIONS

Depressive symptoms in patients with HF have a major effect on the usefulness of DMP. Identification of depressive symptoms before enrollment in a DMP might lead to more accurate use of a DMP, because depressive patients might not benefit from a general program. (Netherlands Heart Foundation Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure; ISRCTN98675639).

摘要

目的

本研究旨在探讨抑郁症状在心力衰竭（HF）患者疾病管理计划（DMP）疗效中的可能作用。

背景

目前的 HF 指南推荐采用疾病管理方案，但某些患者群体，如抑郁患者，对这些方案的反应可能较差。

方法

我们从一项大型多中心研究的数据中，研究了 DMP 在 HF 患者中的疗效，探讨了基线时抑郁症状与该方案疗效之间的潜在相互作用。

结果

在 958 例 HF 患者（37%为女性；年龄 71 +/- 11 岁；纽约心脏协会心功能 II 至 IV 级）中，377 例（39%）患者在基线时报告存在抑郁症状。在 18 个月的随访期间，无抑郁症状患者的主要终点（全因死亡率和 HF 再入院的复合终点）发生率为 39%，而抑郁患者的发生率为 42%。在总体样本中，DMP 对复合主要终点无显著影响。DMP 在无抑郁症状的 HF 患者中的效果与抑郁患者明显不同。抑郁症状对 DMP 治疗全因死亡率和 HF 再入院的效果有显著的修饰作用（p = 0.03）。在无抑郁症状的患者中，DMP 使主要终点的发生率降低（危险比：0.8，95%置信区间：0.61 至 1.04），而在有抑郁症状的患者中则相反（危险比：1.3，95%置信区间：0.95 至 1.98）。