Liguori Ilaria, Russo Gennaro, Curcio Francesco, Sasso Giuseppe, Della-Morte David, Gargiulo Gaetano, Pirozzi Flora, Cacciatore Francesco, Bonaduce Domenico, Abete Pasquale, Testa Gianluca
Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.
Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
J Geriatr Cardiol. 2018 Jun;15(6):451-459. doi: 10.11909/j.issn.1671-5411.2018.06.014.
Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including: psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.
慢性心力衰竭和抑郁症在老年人中具有较高的患病率和发病率。多项研究表明，抑郁症往往会加重并存的慢性心力衰竭及其临床结局，反之亦然，尤其是在老年人中。只有考虑到这两种情况背后多方面的病理生理特征，如行为因素、神经激素激活、炎症介质、高凝状态和血管损伤，才能探讨老年人慢性心力衰竭与抑郁症之间的负协同作用。然而，这两种情况之间的病理生理联系尚未完全明确。尽管慢性心力衰竭老年患者中抑郁症的患病率很高且具有负面预后价值，但它常常未被识别，尤其是因为存在共同症状。因此，建议对慢性心力衰竭老年患者使用可靠的问卷进行情绪障碍筛查，即使这不能替代心理健康专业人员的诊断性访谈。在这种情况下，抑郁症的治疗需要多学科方法，包括：心理治疗、抗抑郁药、运动训练和电休克治疗。尽管结果存在矛盾，但使用选择性5-羟色胺再摄取抑制剂进行药物治疗可改善生活质量，但不能保证更好的结局。运动训练在改善生活质量和预后方面有效，但同时心脏康复服务的利用率极低。
