Li Junlei, Jiang Chao, Liu Rong, Lai Yiwei, Li Li, Zhao Xiaoyan, Wang Xiaofang, Li Ling, Du Xin, Ma Changsheng, Dong Jianzeng
Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2022 Aug 2;9:858751. doi: 10.3389/fcvm.2022.858751. eCollection 2022.
Depression is a prevalent comorbidity in patients with heart failure (HF). However, data regarding the prognostic significance of depression during the early post-discharge period in patients hospitalized with acute HF, regardless of left ventricular ejection fraction (LVEF), were scarce.
The Heart Failure Registry of Patient Outcomes (HERO) study is a prospective, multicenter study of patients hospitalized with acute HF in China. At the first follow-up after discharge (median 4.0, interquartile range [IQR]: 2.4-6.1 weeks), depressive symptoms over the past 2 weeks were assessed using the Patient Health Questionnaire-9 (PHQ-9). Of 3,889 patients, 480 (12.3%) patients had depression (PHQ-9 score ≥ 10). A total of 3,456 patients (11.4% with depression) were included in the prospective analysis. After a median follow-up of 47.1 weeks (IQR: 43.9, 49.3) from the first follow-up, 508 (14.7%) patients died, and 1,479 (42.8%) patients experienced a composite event (death or HF rehospitalization). Cox proportional hazards models were used to assess the association of post-discharge depression with adverse events. After adjustment, post-discharge depression was associated with an increased risk of all-cause mortality (hazard ratio [HR] 2.38 [95% confidence interval (CI): 1.93-2.94]; < 0.001) and the composite event (HR 1.78 [95% CI: 1.55-2.05]; < 0.001). A per scale point increase in PHQ-9 score (ranging from 0 to 27 points) was associated with a 7.6% increase in all-cause mortality (HR 1.08 [95% CI: 1.06-1.09]; < 0.001). In the subgroup analysis, the association between depression and the composite event was significantly stronger in relatively younger patients (< 75 vs. ≥ 75 years; p for interaction = 0.011), and the association between depression and all-cause mortality was significantly stronger in patients with preserved ejection fraction than in those with reduced ejection fraction ( for interaction = 0.036).
Post-discharge depression in patients recently hospitalized with acute HF is associated with an increased risk of adverse events, regardless of LVEF. Screening for depressive symptoms during the early post-discharge period may help to better identify high-risk patients and tailor patient management. Further studies are needed to determine how regular depression screening can help improve patient management and clinical outcomes.
抑郁症是心力衰竭（HF）患者中常见的合并症。然而，关于急性HF住院患者出院后早期抑郁症的预后意义的数据却很稀少，无论其左心室射血分数（LVEF）如何。
心力衰竭患者结局登记（HERO）研究是一项针对中国急性HF住院患者的前瞻性多中心研究。在出院后的首次随访（中位时间4.0周，四分位间距[IQR]：2.4 - 6.1周）时，使用患者健康问卷-9（PHQ-9）评估过去2周的抑郁症状。在3889例患者中，480例（12.3%）有抑郁症（PHQ-9评分≥10）。共有3456例患者（11.4%有抑郁症）纳入前瞻性分析。从首次随访起中位随访47.1周（IQR：43.9，49.3）后，508例（14.7%）患者死亡，1479例（42.8%）患者发生复合事件（死亡或HF再住院）。采用Cox比例风险模型评估出院后抑郁症与不良事件的关联。调整后，出院后抑郁症与全因死亡率增加相关（风险比[HR] 2.38 [95%置信区间（CI）：1.93 - 2.94]；P < 0.001）以及复合事件相关（HR 1.78 [95% CI：1.55 - 2.05]；P < 0.001）。PHQ-9评分每增加一个量表分（范围为0至27分）与全因死亡率增加7.6%相关（HR 1.08 [95% CI：1.06 - 1.09]；P < 0.001）。在亚组分析中，抑郁症与复合事件之间的关联在相对年轻患者（< 75岁与≥ 75岁；交互作用P = 0.011）中显著更强，抑郁症与全因死亡率之间的关联在射血分数保留的患者中比在射血分数降低的患者中显著更强（交互作用P = 0.036）。
近期急性HF住院患者出院后抑郁症与不良事件风险增加相关，无论LVEF如何。在出院后早期筛查抑郁症状可能有助于更好地识别高危患者并调整患者管理。需要进一步研究以确定定期抑郁症筛查如何有助于改善患者管理和临床结局。
