College of Nursing, University of Kentucky, Lexington, KY, USA.
J Cardiovasc Nurs. 2009 Jul-Aug;24(4):299-305; quiz 306-7. doi: 10.1097/JCN.0b013e3181a6a1e5.
Although a low-sodium diet (LSD) is important in self-management of patients with heart failure (HF), the impact of LSD on event-free survival has not been investigated. Depressive symptoms predict worse event-free survival, in part, by affecting adherence to self-management. However, there are few investigations of the relationship among depressive symptoms, adherence to the LSD, and event-free survival.
The purpose of this study was to determine the relationships among adherence to the LSD, depressive symptoms, and event-free survival.
A total of 254 patients (57% male, 62 ± 14 years, 52% New York Heart Association class III/IV, ejection fraction of 36% ± 14%) were recruited from outpatient HF clinics in Korea. Twenty-four-hour urinary sodium excretion was collected as an indicator of patient adherence to the LSD. Patients were grouped based on the cut point of 3 g of urinary sodium excretion. Depressive symptoms were assessed by the Korean version of Beck Depression Inventory, and patients were split into 2 groups at the cutoff of the Korean version of Beck Depression Inventory. Event-free survival for 12 months was determined by medical records. Hierarchical Cox proportional hazards regression was used to determine the association of depressive symptoms and adherence to 3-g sodium intake on event-free survival.
After controlling for age, sex, etiology of HF, body mass index, New York Heart Association class, ejection fraction, N-terminal B-type natriuretic peptide, and total comorbidity score, nonadherence to 3-g sodium intake (hazard ratio = 1.56, 95% confidence interval = 1.05-2.32) and depressive symptoms (hazard ratio = 2.21, 95% confidence interval = 1.47-3.33) independently predicted event-free survival. Patients with sodium intake higher than 3 g and with depressive symptoms demonstrated a 3.7 times higher risk for cardiac events compared with patients with sodium intake lower than 3 g and without depressive symptoms (P < .001).
Improvement of adherence to the LSD and treatment for depressive symptoms could improve event-free survival.
尽管低钠饮食（LSD）对于心力衰竭（HF）患者的自我管理很重要，但 LSD 对无事件生存的影响尚未得到研究。抑郁症状通过影响自我管理的依从性来预测更差的无事件生存，部分原因是这样。然而，关于抑郁症状、LSD 依从性和无事件生存之间的关系的研究很少。
本研究旨在确定 LSD 依从性、抑郁症状和无事件生存之间的关系。
总共招募了 254 名患者（57%为男性，62 ± 14 岁，52%为纽约心脏协会 III/IV 级，射血分数为 36% ± 14%），他们来自韩国的 HF 门诊。24 小时尿钠排泄量被收集作为患者遵守 LSD 的指标。根据 3 克尿钠排泄量的切点将患者分组。抑郁症状通过韩国版贝克抑郁量表进行评估，患者在韩国版贝克抑郁量表的截点处分为 2 组。通过医疗记录确定 12 个月的无事件生存。使用分层 Cox 比例风险回归来确定抑郁症状和 3 克钠摄入量依从性对无事件生存的关联。
在控制年龄、性别、HF 病因、体重指数、纽约心脏协会分级、射血分数、N 末端 B 型利钠肽和总合并症评分后，不遵守 3 克钠摄入量（风险比=1.56，95%置信区间=1.05-2.32）和抑郁症状（风险比=2.21，95%置信区间=1.47-3.33）独立预测无事件生存。钠摄入量高于 3 克且有抑郁症状的患者与钠摄入量低于 3 克且无抑郁症状的患者相比，心脏事件的风险增加了 3.7 倍（P <.001）。
改善 LSD 的依从性和治疗抑郁症状可以提高无事件生存率。
