Safety and Efficacy of Sertraline for Depression CHF

描述(申请人提供)：共病抑郁对内科疾病的重要性最近在医学文献中得到了承认。在患有慢性内科疾病的患者中，包括血管疾病(脑血管疾病和冠状动脉疾病)的患者中，情绪障碍的患病率高于正常人群。其他工作表明，这些患者的住院人数、护理费用、发病率和死亡率都有所增加。200多万美国公民患有充血性心力衰竭(CHF)，在医疗保险人群中占最高的住院类别，每年的费用超过100亿美元。心力衰竭的一个主要来源是缺血性心脏病。尽管人们知道抑郁症会增加缺血性心脏病的发病率、死亡率和较差的预后，但目前对CHF和抑郁症之间的联系知之甚少。有证据表明，在CHF人群中抑郁症的发生率可能很高，但还没有研究表明当抑郁症得到适当治疗时，对CHF患者的发病率和死亡率的影响。要求为两个地点的前瞻性安慰剂治疗充血性心力衰竭患者和临床诊断为严重抑郁症的患者提供资金。这项研究将纳入NYHA Functional&GT；II临床诊断为心力衰竭的患者。患者将接受访谈，并使用由NIMH支持的杜克老年抑郁症研究中心开发的方案对患者进行严重抑郁症的评估。这包括评估抑郁症状、精神并存、认知状态、功能状态和残疾、日常和慢性压力以及社会支持的部分，这项研究的纵向部分将包括收集所有登记受试者的数据。在这些后续接触中收集的信息将包括死亡、再次住院、心脏事件、功能状态/生活质量指标以及抑郁症状的水平。

DESCRIPTION (provided by applicant): The significance of co-morbid depression upon the medically ill has recently been recognized in the medical literature. Higher prevalence rates of mood disorders above that of the normal population has been found in patients who suffer from chronic medical illnesses, including vascular disease (cerebrovascular and coronary artery disease). Additional work has shown increased in-patient hospitalizations, cost of care, morbidity and mortality in these patients. More than 2 million United States citizens suffer from congestive heart failure (CHF), accounting for the highest category for hospitalization in the Medicare population, with annual expenses exceeding $10 billion. One leading source of heart failure is ischemic heart disease. Despite knowledge that depressive disorders lead to increased morbidity, mortality and poorer outcomes in ischemic heart disease, little is currently known about the association of CHF and depression. There is evidence that the rate of depression may be high in the CHF population, but no studies have addressed the impact on morbidity and mortality in CHF patients when depression is adequately treated. Funding is requested for a two site, prospective placebo treatment of patients with congestive heart failure and clinically diagnosed major depression. Patients will be enrolled in this study with clinically diagnosed heart failure of NYHA functional > II. Patients will be interviewed and evaluated for major depression by use of the protocol developed by the NIMH-supported Duke Center for the Study of Depression in the Elderly. This includes sections that assess depressive symptoms, psychiatric co-morbidity, cognitive status, functional status and disability, daily and chronic stress, and social support, the longitudinal component of this study will include collecting data on all enrolled subjects. Information collected in these follow-up contacts will include deaths, re-hospitalizations, cardiac events, functional status/quality of life measures, and level of depressive symptoms.