Antidepressant use, depression, and survival in patients with heart failure.
Antidepressant use, depression, and survival in patients with heart failure.
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心力衰竭患者的抗抑郁药使用，抑郁和生存。
DOI：
10.1001/archinte.168.20.2232
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发表时间：
2008-11-10
影响因子：
--
通讯作者：
Krishnan, Ranga R.
中科院分区：
文献类型：
--
作者：
O'Connor, Christopher M.;Jiang, Wei;Kuchibhatla, Maragatha;Mehta, Rajendra H.;Clary, Greg L.;Cuffe, Michael S.;Christopher, Eric J.;Alexander, Jude D.;Califf, Robert M.;Krishnan, Ranga R.
最近的研究表明，抗抑郁药的使用可能与心脏病患者死亡率增加有关。由于抑郁症也被证明与这些患者的死亡率增加有关，因此尚不清楚这种联系是归因于抗抑郁药的使用还是抑郁症。为了评估长期死亡率与抗抑郁药使用和抑郁症的关系，我们研究了1006例年龄在18岁或以上的临床心力衰竭患者，射血分数为35%或更低（62%伴有缺血性疾病），1997年3月至2003年6月。此后每年对患者进行一次生命状态随访。抑郁状态，这是由贝克抑郁量表（BDI）量表和抗抑郁药的使用进行评估，前瞻性收集。关注的主要结局是长期死亡率。在研究患者中，30.0%患有抑郁症（定义为BDI评分≥10），24.2%正在服用抗抑郁药（其中79.6%的患者仅服用选择性5-羟色胺再摄取抑制剂[SSRI]）。在平均972（731）（平均值[SD]）天的随访中获得所有参与者的生命状态。在此期间，42.7%的参与者死亡。总体而言，使用抗抑郁药（未校正的风险比[HR]，1.32; 95%置信区间[CI]，1.03-1.69）或仅使用SSRI（未校正的HR，1.32; 95% CI，0.99-1.74）与死亡率增加相关。然而，在控制抑郁症和其他混杂因素后，抗抑郁药使用（HR，1.24; 95%CI，0.94-1.64）与死亡率增加之间的相关性不再存在。尽管如此，抑郁症仍与死亡率增加相关（HR，1.33; 95%CI，1.07-1.66）。同样，抑郁（HR，1.34; 95% CI，1.08-1.68）而不是SSRI使用（HR，1.10; 95% CI，0.81-1.50）与校正后死亡率增加独立相关。我们的研究结果表明，抑郁症（定义为BDI评分≥10），而不是抗抑郁药的使用，与心力衰竭患者死亡率增加相关。
Recent studies suggest that the use of antidepressants may be associated with increased mortality in patients with cardiac disease. Because depression has also been shown to be associated with increased mortality in these patients, it remains unclear if this association is attributable to the use of antidepressants or to depression. To evaluate the association of long-term mortality with antidepressant use and depression, we studied 1006 patients aged 18 years or older with clinical heart failure and an ejection fraction of 35% or less (62% with ischemic disease) between March 1997 and June 2003. The patients were followed up for vital status annually thereafter. Depression status, which was assessed by the Beck Depression Inventory (BDI) scale and use of antidepressants, was prospectively collected. The main outcome of interest was long-term mortality. Of the study patients, 30.0% were depressed (defined by a BDI score ≥10) and 24.2% were taking antidepressants (79.6% of these patients were taking selective serotonin reuptake inhibitors [SSRIs] only). The vital status was obtained from all participants at an average follow-up of 972 (731) (mean [SD]) days. During this period, 42.7% of the participants died. Overall, the use of antidepressants (unadjusted hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.03–1.69) or SSRIs only (unadjusted HR, 1.32; 95% CI, 0.99–1.74) was associated with increased mortality. However, the association between antidepressant use (HR, 1.24; 95% CI, 0.94–1.64) and increased mortality no longer existed after depression and other confounders were controlled for. Nonetheless, depression remained associated with increased mortality (HR, 1.33; 95% CI, 1.07–1.66). Similarly, depression (HR, 1.34; 95% CI, 1.08–1.68) rather than SSRI use (HR, 1.10; 95% CI, 0.81–1.50) was independently associated with increased mortality after adjustment. Our findings suggest that depression (defined by a BDI score ≥10), but not antidepressant use, is associated with increased mortality in patients with heart failure.
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3.6
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Richter, P;Werner, J;Sauer, H
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Sauer, H
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Lespérance, F;Frasure-Smith, N;Théroux, P
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Théroux, P