Relationship of depression, anxiety, and social isolation to chronic heart failure outpatient mortality
Relationship of depression, anxiety, and social isolation to chronic heart failure outpatient mortality
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DOI：
10.1016/j.ahj.2006.05.009
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发表时间：
2006-11-01
影响因子：
4.8
通讯作者：
Gottlieb, Stephen S.
中科院分区：
文献类型：
--
作者：
Friedmann, Erika;Thomas, Sue A.;Gottlieb, Stephen S.
目的
心理社会因素结局研究（PFOS）调查了心力衰竭（HF）门诊患者中抑郁和焦虑的患病率，以及心理社会因素与死亡率的关系。
背景
大量证据表明心理社会因素与冠心病死亡率和心源性猝死（SCD）有关。心理社会因素独立于疾病严重程度对心力衰竭门诊患者死亡率的影响尚未得到很好的阐明。
方法
来自20个心力衰竭心脏性猝死试验（SCD - HeFT）站点的153名患者参与了PFOS。SCD - HeFT提供了人口统计学、病史和心脏数据。参与者在进入PFOS时完成问卷调查以评估心理社会状况。
结果
抑郁和焦虑在心力衰竭门诊患者中很常见（36%的贝克抑郁量表 - II≥13；45%的状态 - 特质焦虑量表≥40）。在SCD - HeFT治疗组中，抑郁、焦虑和社会支持量没有差异：植入式心律转复除颤器、胺碘酮和安慰剂药物治疗组。15名（9.8%）患者在平均23.6个月（标准差 = 8.2）的随访期间死亡。在控制治疗的考克斯回归分析中，抑郁、焦虑和社会隔离分别预测死亡率；感知到的心力衰竭特异性功能状态则不能。抑郁（对数）[P = 0.04，风险比（HR）= 1.81]和社会隔离（P = 0.04，HR = 2.25），但焦虑不能，独立于人口统计学、临床预测因素和治疗预测死亡率。当同时纳入显著的人口统计学、临床和心理社会预测因素以及治疗组时，抑郁（对数）（P = 0.022，HR = 2.2）和社会隔离（P = 0.094，HR = 1.75）预测死亡率。抑郁患者的全因死亡率为12%，其他患者为9%。
结论
本研究发现心力衰竭门诊患者中焦虑患病率较高，并证实了抑郁的高患病率。在心力衰竭门诊患者中，抑郁和社会隔离独立于人口统计学和临床状况预测死亡率。
Objectives The Psychosocial Factors Outcome Study (PFOS) investigated the prevalence of depression and anxiety and the relationship of psychosocial factors to mortality in outpatients with heart failure (HF).Background Considerable evidence links psychosocial factors to coronary heart disease mortality and sudden cardiac death (SCD). The contribution of psychosocial factors independent of disease severity to HF outpatient mortality is not well elucidated.Methods Patients (N = 153) from 20 Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) sites participated in the PFOS. SCD-HeFT provided demographic, medical history, and cardiac data. Participants completed questionnaires to assess psychosocial status at PFOS entry.Results Depression and anxiety were common in HF outpatients (36% Beck Depression Inventory-II >= 13; 45% State Trait Anxiety Inventory >= 40). Depression, anxiety, and social support amount did not differ in the SCD-HeFT treatment groups: implantable cardioverter defibrillator, amiodarone, and placebo medication. Fifteen (9.8%) patients died during mean follow-up at 23.6 months (SD = 8.2). In Cox regression controlling for treatment, depression, anxiety, and social isolation separately predicted mortality; perceived HF-specific functional status did not. Depression (In) [P = .04, hazard ratio (HR) = 1.81] and social isolation (P = .04, HR = 2.25), but not anxiety, predicted mortality independent of demographics, clinical predictors, and treatment. When simultaneously including significant demographic, clinical, and psychosocial predictors and treatment groups, depression (In) (P = .022, HR = 2.2) and social isolation (P = .094, HR = 1.75) predicted mortality. All-cause mortality was 12% for depressed patients and 9% for others.Conclusion This study finds a high prevalence of anxiety and confirms the high prevalence of depression in the HIF outpatient population. Depression and social isolation predicted mortality independent of demographic and clinical status in HF outpatients.