Guangdong Provincial Key Laboratory of Clinical Pharmacology Medical Research Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou China.
School of Medicine South China University of Technology Guangzhou China.
J Am Heart Assoc. 2024 May 7;13(9):e032961. doi: 10.1161/JAHA.123.032961. Epub 2024 Apr 30.
Among those with heart failure (HF), women are more likely to develop depression than men. Few studies have focused on the outcomes of female patients with HF with depressive symptoms.
A total of 506 female patients with HF with preserved ejection fraction were included in this secondary analysis from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) cohort, and 439 female patients with HF with reduced ejection fraction were included from the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) cohort. Depressive symptoms were measured using the Patient Health Questionnaire-9 and Beck Depression Inventory-II. The depression class was categorized by severity, and the change in clinical depression class was defined as aggravated (1-grade increase) or improved (1-grade decrease). The prognostic value of depressive symptoms was determined by using multivariable Cox proportional hazards models. Female patients with improved depressive symptoms had worse depressive status at baseline and lower baseline Kansas City Cardiomyopathy Questionnaire scores. Depression class at the 12-month visit and depression class change were the dominant prognostic factors for cardiovascular death in female patients with HF with preserved ejection fraction (hazard ratio [HR], 1.43 [95% CI, 1.02-2.01], =0.036; HR, 1.71 [95% CI, 1.14-2.55], =0.009). Among the patients with HF with reduced ejection fraction, both the depression class at baseline and depression class change had significant prognostic effects on cardiovascular death (HR, 3.30 [95% CI, 1.70-6.39], <0.001; HR, 2.21 [95% CI, 1.28-3.80], =0.004). However, the prognostic value of depressive assessments for hospitalization in patients with HF is unclear.
In female patients with HF with reduced ejection fraction, the depression class at baseline was most strongly associated with cardiovascular death, whereas in female patients with HF with preserved ejection fraction, the change in depression class exhibited a more significant prognostic trend.
在心力衰竭（HF）患者中，女性比男性更容易出现抑郁。很少有研究关注有抑郁症状的女性 HF 患者的结局。
共纳入来自 TOPCAT（醛固酮拮抗剂治疗保留射血分数的心力衰竭）队列的 506 例女性 HF 伴射血分数保留患者和 HF-ACTION（心力衰竭：运动训练的对照试验）队列的 439 例女性 HF 伴射血分数降低患者进行二次分析。使用患者健康问卷-9 和贝克抑郁自评量表评估抑郁症状。根据严重程度对抑郁类别进行分类，定义临床抑郁类别变化为加重（增加 1 级）或改善（降低 1 级）。使用多变量 Cox 比例风险模型确定抑郁症状的预后价值。抑郁症状改善的女性患者在基线时的抑郁状况更差，基线堪萨斯城心肌病问卷评分更低。HF 伴射血分数保留患者中，12 个月时的抑郁类别和抑郁类别变化是心血管死亡的主要预后因素（风险比 [HR]，1.43 [95%CI，1.02-2.01]，=0.036；HR，1.71 [95%CI，1.14-2.55]，=0.009）。在射血分数降低的 HF 患者中，基线时的抑郁类别和抑郁类别变化对心血管死亡均有显著的预后影响（HR，3.30 [95%CI，1.70-6.39]，<0.001；HR，2.21 [95%CI，1.28-3.80]，=0.004）。然而，抑郁评估对 HF 患者住院的预后价值尚不清楚。
在射血分数降低的 HF 女性患者中，基线时的抑郁类别与心血管死亡相关性最强，而在射血分数保留的 HF 女性患者中，抑郁类别的变化表现出更显著的预后趋势。
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