Brouwers Corline, Christensen Stefan B, Damen Nikki L, Denollet Johan, Torp-Pedersen Christian, Gislason Gunnar H, Pedersen Susanne S
CoRPS - Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
Int J Cardiol. 2016 Jan 15;203:867-73. doi: 10.1016/j.ijcard.2015.11.032. Epub 2015 Nov 6.
Depression is a risk factor for mortality in patients with heart failure (HF), however, treating depression with antidepressant therapy does not seem to improve survival. We examined the prevalence of antidepressant use in HF patients, the correlates of antidepressant use subsequent to hospital discharge and the relation between antidepressant use, clinical depression and mortality in patients with HF.
121,252 HF patients surviving first hospitalization were stratified by antidepressant use and a diagnosis of clinical depression.
In total, 15.6% (19,348) received antidepressants at baseline, of which 86.7% (16,780) had no diagnosis of clinical depression. Female gender, older age, higher socio-economic status, more comorbidities, increased use of statins, spironolactone and aspirin, lower use of beta-blockers and ACE-inhibitors, greater HF severity and a diagnosis of clinical depression were independently associated with antidepressant use. Patients using no antidepressants with clinical depression and patients using antidepressants, with or without clinical depression, had a significantly higher risk for all-cause mortality (HR, 1.25; 95% CI, 1.15-1.36; HR, 1.24; 95% CI, 1.22-1.27; HR, 1.21; 95% CI, 1.16-1.27, respectively) and CV-mortality (HR: 1.17; 95% CI, 1.14-1.20, P<.001; HR: 1.20; 95% CI, 1.08-1.34, P<.001; HR: 1.21; 95% CI, 1.12-1.29, P<.001, respectively) as compared to patients not using antidepressants without depression in adjusted analysis.
Patients with HF taking antidepressants had an increased risk for all-cause and CV-mortality, irrespectively of having clinical depression. These results highlight the importance of further examining the antidepressant prescription pattern in patients with HF, as this may be crucial in understanding the antidepressant effects on cardiac function and mortality.
抑郁症是心力衰竭（HF）患者死亡的一个危险因素，然而，使用抗抑郁药物治疗抑郁症似乎并不能提高生存率。我们研究了HF患者中抗抑郁药物的使用情况、出院后使用抗抑郁药物的相关因素以及抗抑郁药物使用、临床抑郁症与HF患者死亡率之间的关系。
121252例首次住院存活的HF患者按抗抑郁药物使用情况和临床抑郁症诊断进行分层。
共有15.6%（19348例）患者在基线时接受了抗抑郁药物治疗，其中86.7%（16780例）未被诊断为临床抑郁症。女性、年龄较大、社会经济地位较高、合并症较多、他汀类药物、螺内酯和阿司匹林的使用增加、β受体阻滞剂和血管紧张素转换酶抑制剂的使用减少、HF严重程度较高以及临床抑郁症诊断与抗抑郁药物使用独立相关。在调整分析中，与未患抑郁症且未使用抗抑郁药物的患者相比，未使用抗抑郁药物的临床抑郁症患者以及使用抗抑郁药物的患者（无论是否患有临床抑郁症）全因死亡率（HR分别为1.25；95%CI为1.15 - 1.36；HR为1.24；95%CI为1.22 - 1.27；HR为1.21；95%CI为1.16 - 1.27）和心血管死亡率（HR分别为1.17；95%CI为1.14 - 1.20，P <.001；HR为1.20；95%CI为1.08 - 1.34，P <.001；HR为1.21；95%CI为1.12 - 1.29，P <.001）的风险显著更高。
无论是否患有临床抑郁症，服用抗抑郁药物的HF患者全因死亡率和心血管死亡率风险均增加。这些结果凸显了进一步研究HF患者抗抑郁药物处方模式的重要性，因为这对于理解抗抑郁药物对心脏功能和死亡率的影响可能至关重要。
