School of Nursing, K6/342 Clinical Sciences Center, University of Wisconsin-Madison, 600 Highland Ave., Madison, WI, 53792-2455, USA,
Qual Life Res. 2014 Aug;23(6):1869-76. doi: 10.1007/s11136-014-0636-5. Epub 2014 Feb 1.
Health-related quality of life (HRQOL) and depressive symptoms both are associated with an adverse prognosis in heart failure (HF), although their associations with outcomes have been examined only in isolation. Therefore, it is unknown how HRQOL and depressive symptoms might interact in their associations with outcomes. The present study was conducted to determine whether the association between HRQOL and cardiac event-free survival is mediated by depressive symptoms in HF patients given that depressive symptoms are associated strongly with HRQOL.
A total of 209 HF patients (61 ± 11 years, 24 % female, 49 % NYHA III/IV) participated. The Minnesota Living with HF Questionnaire and the Patient Health Questionnaire-9 were used to measure HRQOL and depressive symptoms, respectively. Patients were followed for a median of 357 days to determine cardiac event-free survival.
In Cox regression analysis, HRQOL [hazard ratio (HR) 1.013; 95 % confidence interval (CI) 1.001-1.026] and depressive symptoms (HR 1.075; 95 % CI 1.025-1.127) predicted cardiac event-free survival separately, controlling for demographic and clinical variables. HRQOL independently explained 38.7 % of the variance in depressive symptoms (p < 0.05; standardized β = 0.695) in a multiple regression. When HRQOL and depressive symptoms were entered in the model simultaneously, only depressive symptoms independently predicted cardiac event-free survival (HR 1.068; 95 % CI 1.001-1.139), demonstrating a mediation effect of depressive symptoms.
Depressive symptoms mediated the relationship between HRQOL and cardiac event-free survival. Interventions targeting HRQOL to enhance patient outcomes must also address patient depressive symptoms to be fully efficacious.
健康相关生活质量（HRQOL）和抑郁症状均与心力衰竭（HF）的不良预后相关，尽管它们与结局的相关性仅在孤立的情况下进行了研究。因此，尚不清楚 HRQOL 和抑郁症状如何在与结局的相关性中相互作用。本研究旨在确定在 HF 患者中，抑郁症状与 HRQOL 密切相关的情况下，HRQOL 与无心脏事件生存之间的关联是否由抑郁症状介导。
共纳入 209 例 HF 患者（61±11 岁，24%为女性，49%为 NYHA III/IV）。使用明尼苏达州心力衰竭生活质量问卷和患者健康问卷-9 分别测量 HRQOL 和抑郁症状。中位随访 357 天以确定无心脏事件生存。
在 Cox 回归分析中，HRQOL[风险比（HR）1.013；95%置信区间（CI）1.001-1.026]和抑郁症状（HR 1.075；95%CI 1.025-1.127）分别预测了无心脏事件生存，控制了人口统计学和临床变量。HRQOL 可独立解释抑郁症状变异的 38.7%（p<0.05；标准化β=0.695）在多元回归中。当 HRQOL 和抑郁症状同时纳入模型时，只有抑郁症状独立预测了无心脏事件生存（HR 1.068；95%CI 1.001-1.139），表明抑郁症状存在中介效应。
抑郁症状介导了 HRQOL 与无心脏事件生存之间的关系。为增强患者结局而针对 HRQOL 的干预措施还必须解决患者的抑郁症状，才能充分发挥其疗效。
