Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia; School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia.
Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia; School of Health Sciences and Psychology, Federation University, Berwick, VIC 3806, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3010, Australia.
J Psychosom Res. 2018 Jun;109:12-18. doi: 10.1016/j.jpsychores.2018.03.008. Epub 2018 Mar 23.
Depression exacerbates the burden of heart failure and independently predicts mortality. The aim of this study was to investigate which specific symptoms of depression predict all-cause mortality in systolic heart failure patients.
Consecutive outpatients with heart failure and impaired left ventricular ejection fraction (LVEF), attending an Australian metropolitan heart function clinic between 2001 and 2011, were enrolled. The Cardiac Depression Scale (CDS) was completed as a component of usual care. Baseline clinical characteristics were drawn from hospital databases. The primary end-point was all-cause mortality, obtained from the Australian National Death Index.
A total of 324 patients (68.5% male) were included (mean age at enrolment = 66.8 ± 14.36 years), with a median follow-up time of 6.7 years (95% CI 5.97-7.39) and a mortality rate of 50% by the census date. Mean LVEF = 31.0 ± 11.31%, with 25% having NYHA functional class of III or IV. Factor analysis of the CDS extracted six symptom dimensions: Hopelessness, Cognitive Impairment, Anhedonia/Mood, Irritability, Worry, and Sleep Disturbance. Cox regression analyses identified Hopelessness (HR 1.024, 95% CI 1.004-1.045, p = .018) and Cognitive Impairment (HR 1.048, 95% CI 1.005-1.093, p = .028) as independent risk markers of all-cause mortality, following adjustment of known prognostic clinical factors.
Hopelessness and cognitive impairment are stronger risk markers for all-cause mortality than other symptoms of depression in systolic heart failure. These data will allow more specific risk assessment and potentially new targets for more effective treatment and management of depression in this population.
抑郁会加重心力衰竭的负担，并独立预测死亡率。本研究旨在探讨哪些特定的抑郁症状可预测收缩性心力衰竭患者的全因死亡率。
连续入选 2001 年至 2011 年在澳大利亚大都市心脏功能诊所就诊的射血分数降低的心力衰竭患者。在常规护理中完成心脏抑郁量表（CDS）。从医院数据库中提取基线临床特征。主要终点为全因死亡率，通过澳大利亚国家死亡索引获得。
共纳入 324 例患者（68.5%为男性）（入组时的平均年龄为 66.8±14.36 岁），中位随访时间为 6.7 年（95%CI 5.97-7.39），截止日期的死亡率为 50%。平均 LVEF=31.0±11.31%，25%的患者 NYHA 功能分级为 III 或 IV 级。CDS 的因子分析提取了六个症状维度：绝望、认知障碍、快感缺失/情绪、易怒、担忧和睡眠障碍。Cox 回归分析发现，绝望（HR 1.024，95%CI 1.004-1.045，p=0.018）和认知障碍（HR 1.048，95%CI 1.005-1.093，p=0.028）是全因死亡率的独立危险因素，在调整已知的预后临床因素后。
在收缩性心力衰竭患者中，绝望和认知障碍比其他抑郁症状更能预测全因死亡率。这些数据将为这一人群提供更具体的风险评估，并可能为更有效的治疗和管理抑郁症提供新的目标。
