Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Ctra Canyet, 08916 Badalona, Spain.
Int J Cardiol. 2013 Aug 20;167(4):1217-25. doi: 10.1016/j.ijcard.2012.03.143. Epub 2012 Apr 14.
This study was designed to assess whether depression and the use of antidepressants were related to long-term mortality in heart failure.
Heart failure outpatients (n=1017) from a specialized tertiary unit in Spain were prospectively studied for a median follow-up of 5.4 years (IQR 3.1-8.1). Depressive symptoms were assessed using an abbreviated version of the geriatric depression scale. Survival rates during the study period (August 2001 until December 2010) and hazard ratios (HR) for mortality were adjusted by several demographic and clinical variables.
Depressive symptoms were detected in 302 patients (29.7%) at baseline and 222 (21.8%) de novo during follow-up; 304 patients (29.9%) received at least one prescription of antidepressants, mainly selective serotonin reuptake inhibitors (92.8%); 441 patients (43.4%) died. In a multivariate Cox proportional hazard model, depression was associated with an increased all-cause (HR, 1.39; 95% CI, 1.15-1.68), but not cardiovascular, mortality risk after adjustment for several demographic and clinical confounders. The use of any antidepressant was not independently associated with mortality (HR, 0.89; 95% CI, 0.71-1.13), but benzodiazepines showed a protective role (HR, 0.70; 95% CI, 0.57-0.87). On the contrary, fluoxetine prescriptions, but not duration of fluoxetine treatment, were associated with increased mortality (HR, 1.66; 95% CI, 1.13-2.44).
Depressive symptoms are associated with long-term mortality, but the use of antidepressants and benzodiazepines is safe regarding survival in HF patients, although further research is needed considering individual antidepressants separately.
本研究旨在评估抑郁和抗抑郁药的使用与心力衰竭患者的长期死亡率是否相关。
前瞻性研究了西班牙一家专门的三级单位的心力衰竭门诊患者（n=1017），中位随访时间为 5.4 年（IQR 3.1-8.1）。使用老年抑郁量表的简化版评估抑郁症状。在研究期间（2001 年 8 月至 2010 年 12 月）的生存率和死亡率的风险比（HR）通过多个人口统计学和临床变量进行调整。
基线时有 302 名患者（29.7%）存在抑郁症状，随访期间有 222 名（21.8%）患者出现新发抑郁症状；304 名患者（29.9%）至少开具了一种抗抑郁药处方，主要是选择性 5-羟色胺再摄取抑制剂（92.8%）；441 名患者（43.4%）死亡。在多变量 Cox 比例风险模型中，抑郁与全因（HR，1.39；95%CI，1.15-1.68）但与心血管无关的死亡率风险增加相关，在调整了几个人口统计学和临床混杂因素后。使用任何抗抑郁药与死亡率无关（HR，0.89；95%CI，0.71-1.13），但苯二氮䓬类药物显示出保护作用（HR，0.70；95%CI，0.57-0.87）。相反，氟西汀处方，但不是氟西汀治疗的持续时间，与死亡率增加相关（HR，1.66；95%CI，1.13-2.44）。
抑郁症状与长期死亡率相关，但在 HF 患者中，使用抗抑郁药和苯二氮䓬类药物是安全的，尽管需要进一步研究分别考虑个别抗抑郁药。
