Effect of depression on five-year mortality after an acute coronary syndrome
Effect of depression on five-year mortality after an acute coronary syndrome
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DOI：
10.1016/j.amjcard.2005.06.052
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发表时间：
2005-11-01
影响因子：
2.8
通讯作者：
Stewart, DE
中科院分区：
文献类型：
--
作者：
Grace, SL;Abbey, SE;Stewart, DE
先前的研究已经确定了心脏病住院时的抑郁与患者死亡率之间的关系。本研究的目的是探讨急性冠脉综合征患者住院期间的抑郁史和抑郁症对5年全因死亡率的影响。我们在1997年至1999年期间从12个冠心病监护室招募了750名患有不稳定型心绞痛和心肌梗死的患者。测量包括社会人口学和临床数据和贝克抑郁量表（BDI）。数据与管理数据库相关联，以确定5年全因死亡率。使用考克斯比例风险模型调整生存数据。174名参与者（23.2%）自我报告抑郁情绪史> 2周，235名（31.3%）在指数住院时BDI评分升高，105名（14.0%）报告持续性抑郁障碍。115名参与者（15.3%）在住院后5年内死亡。在调整预后指标，如心脏病严重程度，病史，吸烟，住院期间的抑郁症状显着预测死亡率，但抑郁史不是。与住院时BDI评分≥ 10相关的风险比< 10 versus those >范围为2年时的1.90（95%置信区间1.12 - 3.24）至5年时的1.53（95%置信区间1.04 - 2.24）。总之，抑郁症状在住院时而非住院前的重要性强调了早期识别增加的痛苦的必要性，并再次呼吁确定不仅提高生活质量而且降低死亡风险的治疗方法。(c)2005年爱思唯尔公司All rights reserved.
Previous research has established a relation between depression at the time of cardiac hospitalization and patient mortality. The objective of this study was to examine the role of depressive history and symptomatology during hospitalization on 5-year all-cause mortality after admission for an acute coronary syndrome. We recruited 750 patients who had unstable angina pectoris and myocardial infarction from 12 coronary care units between 1997 and 1999. Measurements included sociodemographic and clinic data and the Beck Depression Inventory (BDI). Data were linked to an administrative database to determine 5-year all-cause mortality. Survival data were adjusted using a Cox's proportional hazards model. One hundred seventy-four participants (23.2%) self-reported a history of depressed mood for > 2 weeks, 235 (31.3%) had elevated BDI scores at index hospitalization, with 105 (14.0%) reporting persistent depressive symptomatology. One hundred fifteen participants (15.3%) died by 5 years after hospitalization. After adjusting for prognostic indicators, such as cardiac disease severity, medical history, and smoking, depressive symptornatology during hospitalization was significantly predictive of mortality, but depressive history was not. Hazard ratios associated with BDI scores < 10 versus those >= 10 at hospitalization ranged from 1.90 (95% confidence interval 1.12 to 3.24) at 2 years to 1.53 (95% confidence interval 1.04 to 2.24) at 5 years. In conclusion, the significance of depressive symptornatology at the time of, but not before, hospitalization underlines the need for early identification of increased distress and renews calls to identify treatments that not only improve quality of life but also decrease the risk of mortality. (c) 2005 Elsevier Inc. All rights reserved.