Bobo William V, Ryu Euijung, Petterson Tanya M, Lackore Kandace, Cheng Yijing, Liu Hongfang, Suarez Laura, Preisig Martin, Cooper Leslie T, Roger Veronique L, Pathak Jyotishman, Chamberlain Alanna M
Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
J Comorb. 2020 Dec 24;10:2235042X20984059. doi: 10.1177/2235042X20984059. eCollection 2020 Jan-Dec.
To determine whether a bi-directional relationship exists between depression and HF within a single population of individuals receiving primary care services, using longitudinal electronic health records (EHRs).
This retrospective cohort study utilized EHRs for adults who received primary care services within a large healthcare system in 2006. Validated EHR-based algorithms identified 10,649 people with depression (depression cohort) and 5,911 people with HF (HF cohort) between January 1, 2006 and December 31, 2018. Each person with depression or HF was matched 1:1 with an unaffected referent on age, sex, and outpatient service use. Each cohort (with their matched referents) was followed up electronically to identify newly diagnosed HF (in the depression cohort) and depression (in the HF cohort) that occurred after the index diagnosis of depression or HF, respectively. The risks of these outcomes were compared (vs. referents) using marginal Cox proportional hazard models adjusted for 16 comorbid chronic conditions.
2,024 occurrences of newly diagnosed HF were observed in the depression cohort and 944 occurrences of newly diagnosed depression were observed in the HF cohort over approximately 4-6 years of follow-up. People with depression had significantly increased risk for developing newly diagnosed HF (HR 2.08, 95% CI 1.89-2.28) and people with HF had a significantly increased risk of newly diagnosed depression (HR 1.34, 95% CI 1.17-1.54) after adjusting for all 16 comorbid chronic conditions.
These results provide evidence of a bi-directional relationship between depression and HF independently of age, sex, and multimorbidity from chronic illnesses.
利用纵向电子健康记录（EHRs），确定在接受初级保健服务的单一人群中，抑郁症与心力衰竭（HF）之间是否存在双向关系。
这项回顾性队列研究利用了2006年在一个大型医疗系统中接受初级保健服务的成年人的EHRs。经过验证的基于EHRs的算法在2006年1月1日至2018年12月31日期间识别出10649名患有抑郁症的人（抑郁症队列）和5911名患有HF的人（HF队列）。每例患有抑郁症或HF的人在年龄、性别和门诊服务使用情况方面与一名未受影响的对照者进行1:1匹配。对每个队列（及其匹配的对照者）进行电子随访，以分别确定在抑郁症或HF的索引诊断后发生的新诊断HF（在抑郁症队列中）和抑郁症（在HF队列中）。使用针对16种共病慢性病进行调整的边际Cox比例风险模型比较这些结局的风险（与对照者相比）。
在大约4至6年的随访中，抑郁症队列中观察到2024例新诊断的HF，HF队列中观察到944例新诊断的抑郁症。在对所有16种共病慢性病进行调整后，患有抑郁症的人患新诊断HF的风险显著增加（风险比[HR] 2.08，95%置信区间[CI] 1.89 - 2.28），患有HF的人患新诊断抑郁症的风险显著增加（HR 1.34，95% CI 1.17 - 1.54）。
这些结果提供了证据，表明抑郁症与HF之间存在双向关系，且独立于年龄性别和慢性病的多重共病情况。
