Worsening Depressive Symptoms Are Associated With Adverse Clinical Outcomes in Patients With Heart Failure
| Autor: | Gary G. Koch, Christopher M. O'Connor, Kirkwood F. Adams, Andrew Sherwood, Carla Sueta Dupree, Kristy S. Johnson, Margaret Bowers, Daniel Bensimhon, Robert H. Christenson, Alan L. Hinderliter, Ranak B. Trivedi, James A. Blumenthal |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty heart failure Risk Assessment Severity of Illness Index Article Cohort Studies Age Distribution Predictive Value of Tests Cause of Death Sickness Impact Profile Internal medicine Outpatients Severity of illness Confidence Intervals Odds Ratio medicine Clinical endpoint Humans Hospital Mortality Prospective Studies Cardiac Output Sex Distribution skin and connective tissue diseases Intensive care medicine Depression (differential diagnoses) Aged Cause of death Psychiatric Status Rating Scales business.industry Incidence Hazard ratio Beck Depression Inventory Odds ratio Middle Aged Prognosis Survival Analysis Hospitalization depression Disease Progression Regression Analysis Female sense organs Cardiology and Cardiovascular Medicine business Cohort study |
| Zdroj: | Journal of the American College of Cardiology. 57:418-423 |
| ISSN: | 0735-1097 |
| Popis: | Objectives The purpose of this study was to assess the impact of changes in symptoms of depression over a 1-year period on subsequent clinical outcomes in heart failure (HF) patients. Background Emerging evidence shows that clinical depression, which is prevalent among patients with HF, is associated with a poor prognosis. However, it is uncertain how changes in depression symptoms over time may relate to clinical outcomes. Methods One-hundred forty-seven HF outpatients with ejection fraction of less than 40% were assessed for depressive symptoms using the Beck Depression Inventory (BDI) at baseline and again 1 year later. Cox proportional hazards regression analyses, controlling for established risk factors, were used to evaluate how changes in depressive symptoms were related to a combined primary end point of death or cardiovascular hospitalization over a median follow-up period of 5 years (with a range of 4 to 7 years and no losses to follow-up). Results The 1-year change in symptoms of depression, as indicated by higher BDI scores over a 1-year interval (1-point BDI change hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.02 to 1.12, p = 0.007), was associated with death or cardiovascular hospitalization after controlling for baseline depression (baseline BDI HR: 1.1, 95% CI: 1.06 to 1.14, p < 0.001) and established risk factors, including HF cause, age, ejection fraction, plasma N-terminal pro–B-type natriuretic peptide level, and prior hospitalizations. Conclusions Worsening symptoms of depression are associated with a poorer prognosis in HF patients. Routine assessment of symptoms of depression in HF patients may help to guide appropriate medical management of these patients who are at increased risk for adverse clinical outcomes. |
| Databáze: | OpenAIRE |
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