Health status and depression remission in patients with chronic heart failure: patient-reported outcomes from the SADHART-CHF trial.
Health status and depression remission in patients with chronic heart failure: patient-reported outcomes from the SADHART-CHF trial.
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DOI：
10.1161/circheartfailure.112.967620
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发表时间：
2012-11
期刊：
影响因子：
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通讯作者：
SADHART-CHF Investigators
中科院分区：
文献类型：
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作者：
Xiong GL;Fiuzat M;Kuchibhatla M;Krishnan R;O'Connor CM;Jiang W;SADHART-CHF Investigators
抑郁症是心力衰竭(HF)的一种常见共病，与死亡率、发病率和健康状况的下降密切相关。目前尚不清楚抑郁治疗是否能改善心力衰竭患者的健康状况。SADHART-CHF研究将469名患有慢性心力衰竭(LVEF 45%，NYHA II级)和严重抑郁障碍(MDD)的参与者随机服用舍曲林或安慰剂，为期12周。采用堪萨斯城心肌病问卷(KCCQ)、简明健康调查问卷(SF-36)和6分钟步行试验(6MWT)评定健康状况。调整基线变量和治疗分配，评估治疗组和缓解组之间的健康状况变化。缓解组和未缓解组的最终HDRS评分分别为3.5±2.08和12.97±4.33(p值=0.0001)。在469名参与者中，378名(80.6%)在基线和12周时完成了6MWT，285名(70.1%)完成了KCCQ和SF-36。除自我效能感(p=0.001.18)和症状稳定性(p=0.91)外，抑郁缓解与KCCQ各分量表得分(p<；0.91)的改善显著相关。在SF-36中，除疼痛指数外，抑郁缓解与躯体和精神成分摘要各分量表的显著改善相关(p=0.34)。抑郁症缓解组6MWT较未缓解组改善更明显(与基线比较：63.5±238.78比16.24±115.70米，P=0.03)。抑郁症状缓解的心衰患者在躯体功能、社会功能和生活质量方面有明显改善。
Depression is a common comorbidity in heart failure (HF) and is strongly associated with increased mortality, morbidity, and reduced health status. Whether depression treatment may result in improvement of health status in HF patients with comorbid depression remains unknown. The SADHART-CHF study randomized 469 participants with chronic HF (LVEF 45% and NYHA class II) and major depressive disorder (MDD) DSM-IV criteria) to sertraline or placebo for 12 weeks. The Kansas City Cardiomyopathy Questionnaire (KCCQ), Short Form Health Survey (SF-36), and 6-minute walk test (6MWT) were used to assess health status. Health status changes between treatment arms and remission status were evaluated adjusting for baseline variables and treatment assignment. The final HDRS scores were 3.50±2.08 and 12.97±4.33 in the remission and non-remission groups, respectively (p-value = 0.0001). Of 469 total participants, 378 (80.6%) completed the 6MWT and 285 (70.1%) completed KCCQ and SF-36, at baseline and at week-12. Depression remission was significantly associated with higher improvements in KCCQ subscale scores (p < 0.001) except on the Self-Efficacy (p=0.18) and Symptom Stability (p=0.91). On the SF-36, depression remission was associated with significant improvement in subscales of the Physical and Mental Component Summary except the Pain Index (p=0.34). The 6MWT improved more in depression remission compared to non-remission group (difference from baseline: 63.51±238.78 vs. 16.24±115.70 meters, p=0.03). HF patients whose depressive symptoms remitted had significantly greater improvement in physical function, social function, and quality of life.