Heart Center, Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Heart Center, Beijing First Hospital of Integrative Chinese & Western Medicine, Beijing 100021, China.
Chin Med J (Engl). 2019 May 5;132(9):1045-1052. doi: 10.1097/CM9.0000000000000215.
Depression and anxiety have been correlated with elevated risks for quality-of-life (QOL), adverse outcomes, and medical expenditure in patients with acute coronary syndrome (ACS). However, the relevant data are lacking for Chinese ACS populations, especially regarding different effects of major depression, anxiety, and comorbidity. The objective of this study was to evaluate the dynamic changes of depression and/or anxiety over 12 months and examine the effects of depression, anxiety, and comorbidity on QOL, adverse outcomes, and medical expenditure in Chinese patients with ACS.
For this prospective longitudinal study, a total of 647 patients with ACS were recruited from North China between January 2013 and June 2015. Among them, 531 patients (82.1%) completed 12-month follow-ups. Logistic regression model was utilized for analyzing the association of baseline major depression, anxiety, and comorbidity with 12-month all-cause mortality, cardiovascular events, QOL, and health expenditure.
During a follow-up period of 12 months, 7.3% experienced non-fatal myocardial infarction (MI) and 35.8% cardiac re-hospitalization. Baseline comorbidity, rather than major depression/anxiety, strongly predicted poor 12-month QOL as measured by short-form health survey-12 (odds ratio [OR]: 1.77, 95% confidence interval [CI]: 1.22-2.52, P = 0.003). Regarding 12-month non-fatal MI and cardiac re-hospitalization, baseline anxiety (OR: 2.83, 95% CI: 1.33-5.89, P < 0.01; OR: 4.47, 95% CI: 1.50-13.00, P < 0.01), major depression (OR: 2.58, 95% CI: 1.02-6.15, P < 0.05; OR: 5.22, 95% CI: 1.42-17.57, P < 0.03), and comorbidity (OR: 6.33, 95% CI: 2.96-13.79, P < 0.0001, OR: 14.08, 95% CI: 4.99-41.66, P < 0.0001) were all independent predictors, and comorbidity had the highest predictive value. Number of re-hospitalization stay, admission frequency within 12 months and medical expenditure within 2 months were the highest in patients with ACS with comorbidity.
Major depression and anxiety may predict 12-month non-fatal MI and cardiac re-hospitalization. However, comorbidity has the highest predictive value with greater medical expenditure and worse QOL in Chinese patients with ACS. And depression with comorbid anxiety may be a new target of mood status in patients with ACS.
抑郁和焦虑与急性冠状动脉综合征（ACS）患者的生活质量（QOL）降低、不良结局和医疗支出增加有关。然而，中国 ACS 人群缺乏相关数据，特别是在主要抑郁症、焦虑症和合并症的不同影响方面。本研究旨在评估抑郁症和/或焦虑在 12 个月内的动态变化，并研究抑郁症、焦虑症和合并症对中国 ACS 患者 QOL、不良结局和医疗支出的影响。
本前瞻性纵向研究共纳入 2013 年 1 月至 2015 年 6 月华北地区的 647 例 ACS 患者。其中，531 例（82.1%）完成了 12 个月的随访。采用逻辑回归模型分析基线时的主要抑郁症、焦虑症和合并症与 12 个月内全因死亡率、心血管事件、QOL 和医疗支出的关系。
在 12 个月的随访期间，7.3%的患者发生非致命性心肌梗死（MI），35.8%的患者再次住院。基线合并症而不是主要抑郁症/焦虑症，强烈预测了使用短格式健康调查 12 项（SF-12）测量的 12 个月 QOL 不良（比值比 [OR]：1.77，95%置信区间 [CI]：1.22-2.52，P=0.003）。对于 12 个月的非致命性 MI 和再住院，基线焦虑症（OR：2.83，95%CI：1.33-5.89，P<0.01；OR：4.47，95%CI：1.50-13.00，P<0.01）、主要抑郁症（OR：2.58，95%CI：1.02-6.15，P<0.05；OR：5.22，95%CI：1.42-17.57，P<0.03）和合并症（OR：6.33，95%CI：2.96-13.79，P<0.0001；OR：14.08，95%CI：4.99-41.66，P<0.0001）均为独立预测因子，且合并症的预测价值最高。合并症患者的再住院次数、12 个月内住院次数和 2 个月内医疗支出最高。
主要抑郁症和焦虑症可能预测 12 个月的非致命性 MI 和心脏再入院。然而，合并症对中国 ACS 患者具有最高的预测价值，其医疗支出更高，QOL 更差。并且合并焦虑症的抑郁症可能是 ACS 患者情绪状态的一个新目标。
