Depression and rehospitalization following acute myocardial infarction.
Depression and rehospitalization following acute myocardial infarction.
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DOI：
10.1161/circoutcomes.111.961896
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发表时间：
2011-11-01
期刊：
影响因子：
--
通讯作者：
Carney RM
中科院分区：
文献类型：
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作者：
Reese RL;Freedland KE;Steinmeyer BC;Rich MW;Rackley JW;Carney RM
抑郁症状问卷得分升高预测急性心肌梗死（AMI）后再住院。DSM-IV抑郁障碍是否预测AMI后再住院尚不清楚。ENRICHD辅助研究的参与者（n=766）通过诊断访谈分为AMI后无抑郁、轻度抑郁或重度抑郁。对心脏再住院进行了长达42个月的跟踪。采用考克斯比例风险回归模型对抑郁症对首次心脏再住院时间的影响进行建模，控制死亡风险因素。采用逻辑回归分析比较抑郁症诊断或贝克抑郁量表（BDI）预测再住院的准确性。次要分析研究了抑郁症对全因再住院累积次数、住院时间和急诊就诊的影响。与非抑郁症患者相比，患有重度或轻度抑郁症的患者住院时间更早（轻微：校正HR，2.22; 95% CI，1.59至3.08; P<.001;严重：校正HR，2.54; 95% CI，1.84至3.53; P<.001），（轻微：P<0.001;严重：P<0.001）和急诊科就诊（轻微：P= 0.003;严重：P<0.001），在医院呆的时间更长（轻微：P<0.001;严重：P<0.001）。评估抑郁症的访谈和问卷调查方法在预测再住院的总体准确性方面没有显着差异。抑郁障碍增加AMI后再住院的风险。未来的工作应该集中在开发多变量模型来预测AMI后再住院的风险，抑郁症应该包括在这些模型中。
Elevated scores on depression symptom questionnaires predict rehospitalization after acute myocardial infarction (AMI). Whether DSM-IV depressive disorders predict rehospitalization after AMI is unknown. Participants (n=766) in an ENRICHD ancillary study were classified by diagnostic interview as having no depression, minor depression, or major depression after AMI. Cardiac rehospitalizations were tracked for up to 42 months. Cox proportional hazards regression was used to model the effect of depressive disorder on time to first cardiac rehospitalization, controlling for mortality risk factors. Logistic regression was used to compare the accuracy with which rehospitalization could be predicted by depression diagnosis or by the Beck Depression Inventory (BDI). Secondary analyses examined the effects of depression on the cumulative number of all-cause rehospitalizations, length of stay, and emergency department visits. Compared to nondepressed patients, those with either major or minor depression were hospitalized sooner (minor: adjusted HR, 2.22; 95% CI, 1.59 to 3.08; P<.001; major: adjusted HR, 2.54; 95% CI, 1.84 to 3.53; P<.001), had more hospitalizations (minor: P<.001; major: P<.001) and emergency department visits (minor: P=.003; major: P<.001), and spent more days in the hospital (minor: P<.001; major: P<.001). The interview and questionnaire methods of assessing depression did not significantly differ in their overall accuracy of predicting rehospitalization. Depressive disorders increase the risk of rehospitalization after AMI. Future work should focus on developing multivariable models to predict risk of rehospitalization after AMI, and depression should be included in these.