Bhatt Kunal N, Kalogeropoulos Andreas P, Dunbar Sandra B, Butler Javed, Georgiopoulou Vasiliki V
Emory University, Atlanta, GA, United States.
Stony Brook University, Stony Brook, NY, United States.
Int J Cardiol. 2016 Oct 15;221:246-50. doi: 10.1016/j.ijcard.2016.07.057. Epub 2016 Jul 5.
The Patient Health Questionnaire 9 (PHQ-9) is an effective tool for identification and grading of depression symptoms. Data on PHQ-9 utility for patients with heart failure (HF) are limited.
We evaluated the severity of depression by PHQ-9 at baseline and its association with health care resource utilization (HCRU) rates and quality of life (QoL) in 308 outpatients enrolled in a prospective HF cohort study. Depression symptoms were stratified according to PHQ-9 score as minimal (0-4), mild (5-9), or moderate-to-severe (10-27).
Mean age of patients was 57±11years; 65% were men; 50% were white and 47% black; ejection fraction was 30±15%. Over 24±12months (total: 625person-years), there were 41 (13.3%) major clinical events (34 deaths, 5 transplants, 2 ventricular assist device implantations), 633 all-cause admissions (249 [39.3%] for HF), and 362 emergency department (ED) visits. Moderate-to-severe depressive symptoms were associated with 70% more all-cause admissions compared to patients without depressive symptoms and 2.5 times more HF-related admissions. However, less than 50% of patients with moderate-to-severe symptoms were on antidepressants. In adjusted analyses, even mild depressive symptoms were associated with 57% more all-cause admissions compared to patients without depressive symptoms and more than 2-fold higher rate of HF-related admissions. Depressive symptoms were not associated with ED visits. Increasing PHQ-9 score was associated with progressively worse QoL. PHQ-9 was not associated with major clinical events.
PHQ-9 effectively identifies HF patients at risk for increased HCRU and lower QoL. Interventions to reduce depression symptoms may help improve HF outcomes.
患者健康问卷9（PHQ-9）是识别和分级抑郁症状的有效工具。关于PHQ-9在心力衰竭（HF）患者中的应用数据有限。
我们在一项前瞻性HF队列研究中，对308名门诊患者在基线时采用PHQ-9评估抑郁严重程度，并评估其与医疗资源利用（HCRU）率及生活质量（QoL）的关联。抑郁症状根据PHQ-9评分分为轻微（0-4）、轻度（5-9）或中度至重度（10-27）。
患者的平均年龄为57±11岁；65%为男性；50%为白人，47%为黑人；射血分数为30±15%。在24±12个月（总计625人年）期间，发生了41例（13.3%）主要临床事件（34例死亡、5例移植、2例心室辅助装置植入）、633次全因住院（249例[39.3%]因HF住院）以及362次急诊就诊。与无抑郁症状的患者相比，中度至重度抑郁症状与全因住院率高70%以及HF相关住院率高2.5倍相关。然而，中度至重度症状患者中使用抗抑郁药的比例不到50%。在调整分析中，即使是轻度抑郁症状与无抑郁症状的患者相比，全因住院率也高57%，且HF相关住院率高出2倍多。抑郁症状与急诊就诊无关。PHQ-9评分升高与生活质量逐渐变差相关。PHQ-9与主要临床事件无关。
PHQ-9能有效识别有HCRU增加和生活质量降低风险的HF患者。减轻抑郁症状的干预措施可能有助于改善HF结局。
