Division of Cardiology, Massachusetts General Hospital, Boston, USA.
Division of Neurology, Yale School of Medicine, Connecticut, USA.
J Psychiatr Res. 2019 Jan;108:7-23. doi: 10.1016/j.jpsychires.2018.10.007. Epub 2018 Oct 25.
Depression independently predicts poor outcomes in heart failure (HF) patients, including increased mortality, morbidity and 30-day re-hospitalization. In this network meta-analysis, we compared different interventions designed to treat depression in HF.
Electronic searches were conducted using Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and PsycINFO up to November 2016. Included randomized clinical trials (RCTs) compared interventions (Exercise therapy (ET), cognitive behavioral therapy (CBT) or antidepressant (AD) medications) for depression in heart failure patients. The primary outcome was change in depressive symptoms based on validated measures of depression. Network meta-analysis based on random effects model estimating standardized mean difference (SMD) with 95% confidence interval (CI), compared the effects of the 3 classes of interventions with respect to usual care or placebo control conditions.
A total of 21 RCTs (including 4563 HF patients) reporting the effects of treating depression in HF patients were included in the analysis. In comparison to placebo or usual standard of care, ET (SMD -0.38; 95% CI -0.54 to -0.22) and CBT (SMD -0.29; 95% CI -0.58 to -0.01) were associated with reduction in depressive symptoms whereas AD (SMD -0.16; 95% CI -0.44 to 0.11) was less effective.
This meta-analysis is suggestive of therapeutic benefit of ET and CBT in comparison to usual standard of care in treating depression in HF patients. However, comparison among the three interventions was not conclusive. Future randomized clinical trials are warranted to compare the therapeutic effects of ET, CBT and AD in such patients.
抑郁症独立预测心力衰竭（HF）患者预后不良，包括死亡率、发病率和 30 天再住院率增加。在这项网络荟萃分析中，我们比较了不同干预措施治疗 HF 患者抑郁症的效果。
使用 Ovid MEDLINE、EMBASE、CINAHL、Web of Science 和 PsycINFO 电子检索至 2016 年 11 月。纳入的随机临床试验（RCT）比较了治疗心力衰竭患者抑郁症的干预措施（运动疗法（ET）、认知行为疗法（CBT）或抗抑郁药（AD）药物）。主要结局是基于经过验证的抑郁量表评估抑郁症状的变化。基于随机效应模型的网络荟萃分析，估计标准化均数差（SMD）和 95%置信区间（CI），比较了 3 类干预措施与常规护理或安慰剂对照条件的效果。
共纳入 21 项 RCT（包括 4563 例 HF 患者），报告了治疗 HF 患者抑郁症的效果。与安慰剂或常规标准护理相比，ET（SMD -0.38；95%CI -0.54 至 -0.22）和 CBT（SMD -0.29；95%CI -0.58 至 -0.01）与抑郁症状的减轻相关，而 AD（SMD -0.16；95%CI -0.44 至 0.11）效果较差。
本荟萃分析提示与常规标准护理相比，ET 和 CBT 对 HF 患者抑郁症的治疗有益。然而，这三种干预措施之间的比较尚无定论。需要进一步的随机临床试验来比较 ET、CBT 和 AD 在这类患者中的治疗效果。
