Suzuki Tsuyoshi, Shiga Tsuyoshi, Nishimura Katsuji, Omori Hisako, Tatsumi Fujio, Hagiwara Nobuhisa
Department of Cardiology, Tokyo Women's Medical University, Japan.
Department of Psychiatry, Tokyo Women's Medical University, Japan.
Intern Med. 2019 Jun 15;58(12):1689-1694. doi: 10.2169/internalmedicine.2034-18. Epub 2019 Feb 25.
Objective Depression is common in patients with heart failure (HF) and is a possible risk factor for adverse outcomes. The aim of this study was to determine the prevalence of depression assessed by the 2-item Patient Health Questionnaire (PHQ-2) and the effect of depression on outcomes in Japanese outpatients with HF. Methods This sub-analysis of a prospective observational study assessed 976 patients with HF (mean age 66±13 years; 26.7% female; 42.7% with an ischemic etiology). Depression was defined as a PHQ-2 score ≥3. The main composite outcome was death from any cause or hospitalization due to worsening HF. PHQ-2 items were extracted from the PHQ-9 results. To evaluate the association of PHQ-2 scores with outcomes, Cox proportional hazards models were evaluated. Results Fifty-seven (5.8%) patients were diagnosed with depression. During a median follow-up of 21 months, the incidence rates for death from any cause and hospitalization due to worsening HF in patients with and without depression were 2.2 vs. 0.9 per 100 person-years and 6.7 vs. 1.6, p<0.001, respectively. There was a higher incidence of the main outcome in patients with depression than in those without depression (p<0.001). After adjustment for conventional risk factors, depression (PHQ-2 ≥3) was an independent predictor of the main outcome (hazard ratio 2.41, 95% confidence interval 1.14-4.67, p=0.022), and a score for item 1 of the PHQ-2 (loss of interest or pleasure) ≥2 was also an independent risk factor (hazard ratio 3.57, 95% confidence interval 1.85-6.46, p<0.001). Conclusion Depression as assessed by the PHQ-2 was identified in 5.8% of Japanese outpatients with HF and was associated with outcomes.
目的 抑郁症在心力衰竭（HF）患者中很常见，并且是不良结局的一个潜在危险因素。本研究的目的是确定通过二项式患者健康问卷（PHQ-2）评估的抑郁症患病率以及抑郁症对日本HF门诊患者结局的影响。方法 这项前瞻性观察性研究的亚分析评估了976例HF患者（平均年龄66±13岁；26.7%为女性；42.7%病因是缺血性）。抑郁症定义为PHQ-2评分≥3分。主要复合结局是任何原因导致的死亡或因HF恶化而住院。PHQ-2项目是从PHQ-9结果中提取的。为了评估PHQ-2评分与结局的关联，对Cox比例风险模型进行了评估。结果 57例（5.8%）患者被诊断为抑郁症。在中位随访21个月期间，有抑郁症和无抑郁症患者中任何原因导致的死亡和因HF恶化而住院的发生率分别为每100人年2.2例对0.9例以及6.7例对1.6例，p<0.001。抑郁症患者的主要结局发生率高于无抑郁症患者（p<0.001）。在对传统危险因素进行调整后，抑郁症（PHQ-2≥3）是主要结局的独立预测因素（风险比2.41，95%置信区间1.14 - 4.67，p = 0.022），并且PHQ-2第1项（兴趣或愉悦感丧失）评分≥2也是独立危险因素（风险比3.57，95%置信区间1.85 - 6.46，p<0.
