Khodneva Yulia, Ringel Joanna Bryan, Rajan Mangala, Goyal Parag, Jackson Elizabeth A, Sterling Madeline R, Cherrington Andrea, Oparil Suzanne, Durant Raegan, Safford Monika M, Levitan Emily B
Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA.
Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA.
Eur Heart J Open. 2022 Oct 3;2(5):oeac064. doi: 10.1093/ehjopen/oeac064. eCollection 2022 Sep.
To ascertain whether depressive symptoms and cognitive impairment (CI) are associated with mortality among patients with heart failure (HF), adjusting for sociodemographic, comorbidities, and biomarkers.
We utilized Medicare-linked data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a biracial prospective ongoing cohort of 30 239 US community-dwelling adults, recruited in 2003-07. HF diagnosis was ascertained in claims analysis. Depressive symptoms were defined as a score ≥4 on the four-item Center for Epidemiological Studies-Depression scale. Cognitive impairment was defined as a score of ≤4 on the six-item screener that assessed three-item recall and orientation to year, month, and day of the week. Sequentially adjusted Cox proportional hazard models were used to estimate the risk of death. We analyzed 1059 REGARDS participants (mean age 73, 48%-African American) with HF; of those 146 (14%) reported depressive symptoms, 136 (13%) had CI and 31 (3%) had both. Over the median follow-up of 6.8 years (interquartile range, 3.4-10.3), 785 (74%) died. In the socio-demographics-adjusted model, CI was significantly associated with increased mortality, hazard ratio 1.24 (95% confidence interval 1.01-1.52), compared with persons with neither depressive symptoms nor CI, but this association was attenuated after further adjustment. Neither depressive symptoms alone nor their comorbidity with CI was associated with mortality. Risk factors of all-cause mortality included: low income, comorbidities, smoking, physical inactivity, and severity of HF.
Depressive symptoms, CI, or their comorbidity was not associated with mortality in HF in this study. Treatment of HF in elderly needs to be tailored to cognitive status and includes focus on medical comorbidities.
在对社会人口统计学、合并症和生物标志物进行校正的情况下，确定抑郁症状和认知障碍（CI）是否与心力衰竭（HF）患者的死亡率相关。
我们利用了来自“中风地理和种族差异原因”（REGARDS）研究的与医疗保险相关的数据，该研究是一项正在进行的双种族前瞻性队列研究，于2003年至2007年招募了30239名美国社区居住成年人。通过索赔分析确定HF诊断。抑郁症状定义为在四项流行病学研究中心抑郁量表上得分≥4。认知障碍定义为在评估三项回忆以及对年份、月份和星期几的定向的六项筛查量表上得分≤4。使用逐步校正的Cox比例风险模型来估计死亡风险。我们分析了1059名患有HF的REGARDS参与者（平均年龄73岁，48%为非裔美国人）；其中146人（14%）报告有抑郁症状，136人（13%）有CI，31人（3%）两者都有。在中位随访6.8年（四分位间距，3.4 - 10.3年）期间，785人（74%）死亡。在经社会人口统计学校正的模型中，与既无抑郁症状也无CI的人相比，CI与死亡率增加显著相关，风险比为1.24（95%置信区间1.01 - 1.52），但在进一步校正后这种关联减弱。单独的抑郁症状或其与CI的合并症均与死亡率无关。全因死亡率的风险因素包括：低收入、合并症、吸烟、身体不活动以及HF的严重程度。
在本研究中，抑郁症状、CI或它们的合并症与HF患者的死亡率无关。老年HF的治疗需要根据认知状态进行调整，包括关注医学合并症。
