Edwards Katharine S, Chow Eric K H, Dao Catherine, Hossepian Derik, Johnson Audrey G, Desai Manisha, Shah Sonia, Lee Anson, Yeung Alan C, Fischbein Michael, Fearon William F
Department of Medicine, Stanford University, United States of America.
Quantitative Sciences Unit, Stanford University, United States of America.
Int J Cardiol. 2020 Dec 15;321:61-68. doi: 10.1016/j.ijcard.2020.08.007. Epub 2020 Aug 13.
Depression is a significant concern after cardiac surgery and has not been studied in patients undergoing transcatheter aortic valve replacement (TAVR). We sought to examine the prevalence of pre-procedure depression and anxiety symptoms and explore whether brief bedside cognitive behavioral therapy (CBT) could prevent post-TAVR psychological distress.
We prospectively recruited consecutive TAVR patients and randomized them to receive brief CBT or treatment as usual (TAU) during their hospitalization. Multi-level regression techniques were used to evaluate changes by treatment arm in depression, anxiety, and quality of life from baseline to 1 month post-TAVR adjusted for sex, race, DM, CHF, MMSE, and STS score.
One hundred and forty six participants were randomized. The mean age was 82 years, and 43% were female. Self-reported depression and anxiety scores meeting cutoffs for clinical level distress were 24.6% and 23.2% respectively. Both TAU and CBT groups had comparable improvements in depressive symptoms at 1-month (31% reduction for TAU and 35% reduction for CBT, p = .83). Similarly, both TAU and CBT groups had comparable improvements in anxiety symptoms at 1-month (8% reduction for TAU and 11% reduction for CBT, p = .1). Quality of life scores also improved and were not significantly different between the two groups.
Pre-procedure depression and anxiety may be common among patients undergoing TAVR. However, TAVR patients show spontaneous improvement in depression and anxiety scores at 1-month follow up, regardless of brief CBT. Further research is needed to determine whether more tailored CBT interventions may improve psychological and medical outcomes.
抑郁症是心脏手术后的一个重要问题，而经导管主动脉瓣置换术（TAVR）患者尚未得到研究。我们试图研究术前抑郁和焦虑症状的患病率，并探讨简短的床边认知行为疗法（CBT）是否可以预防TAVR术后的心理困扰。
我们前瞻性地连续招募TAVR患者，并将他们随机分为在住院期间接受简短CBT或常规治疗（TAU）。采用多水平回归技术评估治疗组从基线到TAVR术后1个月的抑郁、焦虑和生活质量变化，并对性别、种族、糖尿病、心力衰竭、简易精神状态检查表（MMSE）和胸外科医师协会（STS）评分进行校正。
146名参与者被随机分组。平均年龄为82岁，43%为女性。自我报告的抑郁和焦虑评分达到临床痛苦水平临界值的分别为24.6%和23.2%。TAU组和CBT组在1个月时抑郁症状均有类似改善（TAU组降低31%，CBT组降低35%，p = 0.83）。同样，TAU组和CBT组在1个月时焦虑症状均有类似改善（TAU组降低8%，CBT组降低11%，p = 0.1）。生活质量评分也有所改善，两组之间无显著差异。
术前抑郁和焦虑在接受TAVR的患者中可能很常见。然而，无论是否接受简短CBT，TAVR患者在1个月随访时抑郁和焦虑评分均有自发改善。需要进一步研究以确定更具针对性的CBT干预措施是否可以改善心理和医疗结局。
