Physical activity and depression predict event-free survival in heart transplant candidates.
Physical activity and depression predict event-free survival in heart transplant candidates.
复制标题
体力活动和抑郁可预测心脏移植候选者的无事件生存期
DOI：
10.1037/hea0000033
复制
发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Weidner
中科院分区：
文献类型：
--
作者：
Spaderna;Vögele;Barten;J. M. A;Bunyamin;Weidner
目的：本研究前瞻性评估参加“等待新心脏研究”的门诊患者在等待心脏移植期间身体活动（PA）、抑郁和焦虑与无事件生存的关系。方法对227例新登记的非住院心脏移植患者的资料进行分析。每天的PA（活动次数，热量消耗），抑郁和焦虑在上市时通过问卷进行评估。事件定义为死亡、紧急移植、因临床恶化而退市和机械循环支持装置植入。使用Cox比例风险模型分析PA评分、抑郁和焦虑与无事件生存的关系。协变量包括年龄、性别、体重指数和疾病严重程度的客观指标。结果中位随访478天（6 - 1849天），共发生132例事件（46例死亡，20例机械循环支持装置植入，54例紧急移植，12例摘牌）。较高的活动次数与经历事件的风险比（HR）降低显著相关（HR= 0.88, 95% CI[0.81, 0.96]），而抑郁增加了这种风险（HR= 1.64, 95% CI[1.16, 2.32]）。在多变量分析中，这两种效应仍然显著(HR= 0.91, 95% CI [0.83, 0.99]； HR= 1.60, 95% CI [1.12, 2.29], ps<。02)。PA评分与情绪之间没有显著的相互作用，焦虑与生存无关。结论每日PA和无抑郁均可延长非卧床心脏移植患者的无事件生存期。这些发现独立于疾病严重程度的客观测量。等待心脏移植的患者可能受益于以增加日常PA和减少抑郁症状为重点的干预措施。
ObjectiveThis study prospectively evaluated the relationship of physical activity (PA), depression, and anxiety to event-free survival during waiting time for heart transplantation in ambulatory patients enrolled in the Waiting for a New Heart Study.MethodData from 227 ambulatory patients newly listed for heart transplantation were analyzed. Everyday PA (number of activities, caloric expenditure), depression, and anxiety at time of listing were assessed via questionnaires. Events were defined as death, high-urgency transplantation, delisting due to clinical deterioration, and mechanical circulatory support device implantation. Associations of PA scores, depression, and anxiety with event-free survival were analyzed using Cox proportional hazards models. Covariates included age, sex, body mass index, and objective indicators of disease severity.ResultsAfter a median follow-up of 478 days (6–1,849 days), 132 events occurred (46 deaths, 20 mechanical circulatory support device implantations, 54 high-urgency transplantations, 12 delistings). A higher number of activities was significantly associated with a reduced hazard ratio (HR) to experience an event (HR= 0.88, 95% CI [0.81, 0.96]), and depression increased this risk (HR= 1.64, 95% CI [1.16, 2.32]). Both effects remained significant in multivariate analyses (HR= 0.91, 95% CI [0.83, 0.99]; HR= 1.60, 95% CI [1.12, 2.29], ps<. 02). No significant interactions between PA scores and emotions were observed and anxiety was unrelated to survival.ConclusionBoth everyday PA and the absence of depression prolonged event-free survival in ambulatory heart transplant candidates. These findings were independent of objective measures of disease severity. Patients waiting for cardiac transplantation may benefit from interventions focused on increasing their everyday PA and reducing depressive symptoms.