接受经导管或手术主动脉瓣置换术的老年患者中抑郁与死亡率的关系。
Association of Depression With Mortality in Older Adults Undergoing Transcatheter or Surgical Aortic Valve Replacement.
机构信息
Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.
Division of Vascular Surgery, McGill University, Montreal, Quebec, Canada.
出版信息
JAMA Cardiol. 2018 Mar 1;3(3):191-197. doi: 10.1001/jamacardio.2017.5064.
IMPORTANCE
Depression is increasingly recognized as a risk factor for adverse outcomes in cardiovascular disease. However, little is known about depression in older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement.
OBJECTIVE
To determine the prevalence of depression and its association with all-cause mortality in older adults undergoing TAVR or SAVR.
DESIGN, SETTING, AND PARTICIPANTS: This preplanned analysis of the Frailty Aortic Valve Replacement (FRAILTY-AVR) prospective cohort study included 14 centers in 3 countries from November 15, 2011, through April 7, 2016. Individuals 70 years or older who underwent TAVR or SAVR were enrolled. Depressive symptoms were evaluated using the Geriatric Depression Scale Short Form at baseline and follow-up.
MAIN OUTCOMES AND MEASURES
All-cause mortality at 1 and 12 months after TAVR or SAVR. Logistic regression was used to determine the association of depression with mortality after adjusting for confounders such as frailty and cognitive impairment.
RESULTS
Among 1035 older adults (427 men [41.3%] and 608 women [58.7%]) with a mean (SD) age of 81.4 (6.1) years, 326 (31.5%) had a positive result of screening for depression, whereas only 89 (8.6%) had depression documented in their clinical record. After adjusting for clinical and geriatric confounders, baseline depression was found to be associated with mortality at 1 month (odds ratio [OR], 2.20; 95% CI, 1.18-4.10) and at 12 months (OR, 1.532; 95% CI, 1.03-2.24). Persistent depression, defined as baseline depression that was still present 6 months after the procedure, was associated with a 3-fold increase in mortality at 12 months (OR, 2.98; 95% CI, 1.08-8.20).
CONCLUSIONS AND RELEVANCE
One in 3 older adults undergoing TAVR or SAVR had depressive symptoms at baseline and a higher risk of short-term and midterm mortality. Patients with persistent depressive symptoms at follow-up had the highest risk of mortality.
重要提示
抑郁日益被视为心血管疾病不良预后的风险因素。然而，对于行经导管主动脉瓣置换术（TAVR）或外科主动脉瓣置换术（SAVR）的老年患者的抑郁情况，人们知之甚少。
目的
确定行经导管主动脉瓣置换术（TAVR）或外科主动脉瓣置换术（SAVR）的老年患者中抑郁的发生率及其与全因死亡率的关系。
设计、地点和参与者：本研究是对 Frailty Aortic Valve Replacement（FRAILTY-AVR）前瞻性队列研究的预先计划分析，共纳入了来自 3 个国家的 14 个中心，研究时间为 2011 年 11 月 15 日至 2016 年 4 月 7 日。纳入了 70 岁及以上行 TAVR 或 SAVR 的患者。在基线和随访时使用老年抑郁量表短式版评估抑郁症状。
主要结局和测量指标
TAVR 或 SAVR 后 1 个月和 12 个月的全因死亡率。采用 logistic 回归确定调整衰弱和认知障碍等混杂因素后，抑郁与死亡率之间的关系。
结果
在 1035 名平均（SD）年龄为 81.4（6.1）岁的老年患者（男 427 例[41.3%]，女 608 例[58.7%]）中，326 例（31.5%）筛查出抑郁阳性，而仅 89 例（8.6%）在其临床记录中记录有抑郁。在调整临床和老年混杂因素后，基线时的抑郁与 1 个月时的死亡率相关（比值比[OR]，2.20；95%CI，1.18-4.10）和 12 个月时的死亡率相关（OR，1.532；95%CI，1.03-2.24）。持续性抑郁定义为术后 6 个月时仍存在的基线抑郁，与 12 个月时的死亡率增加 3 倍相关（OR，2.98；95%CI，1.08-8.20）。
结论和相关性
在行 TAVR 或 SAVR 的老年患者中，1/3 患者在基线时存在抑郁症状，且短期和中期死亡率风险增加。在随访时存在持续性抑郁症状的患者死亡率风险最高。
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