DEPRESSION AND REHOSPITALIZATION IN PATIENTS WITH HEART FAILURE

心力衰竭患者的抑郁和再住院

• 批准号: 8822916
• 负责人: KENNETH E FREEDLAND
• 金额: $ 68.92万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-03-15 至 2019-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8822916
• 关键词: Address; Admission activity; Adult; Affect; African American; Anxiety; Caring; Cessation of life; Comorbidity; Computerized Medical Record; Data; Depressed mood; Depressive disorder; Diagnosis; Diagnostic and Statistical Manual of Mental Disorders; Elderly; Enrollment; Event; Fostering; Frequencies; Health; Heart; Heart failure; Hospitalization; Hospitals; Intervention; Interview; Investigation; Life; Measures; Mediator of activation protein; Medical; Medical Records; Mental Depression; Methods; Modeling; Participant; Patients; Pharmaceutical Preparations; Prevention; Questionnaires; Race; Recurrence; Research; Risk; Risk Factors; Self Care; Severities; Side; Social support; Stress; Structure; Subgroup; System; Teaching Hospitals; Testing; Time; United States Centers for Medicare and Medicaid Services; burden of illness; cohort; coping; cost; functional decline; functional disability; indexing; informant; longitudinal course; meetings; mortality; novel; patient population; predictive modeling; pressure; programs

DESCRIPTION (provided by applicant): Heart failure (HF) is the leading cause of hospitalization in older adults. Multiple re-hospitalizations, many of which are preventable, are common in HF and contribute substantially to the cumulative burden of illness and cost of care. The rate of HF re-hospitalization is higher in African-American than in white patients, for reasons that are poorly understood. Current HF readmission risk prediction models are inadequate, and re-hospitalization prevention efforts are ineffective. Research is needed on novel risk factors for HF re-hospitalization. Depression is one of the best candidates for further investigation. It is a prevalent comorbidity in HF, and preliminary evidence suggests that it may increase the rate of re-hospitalization. In addition, the progression of HF and multiple re-hospitalizations may contribute to the persistence or worsening of depression. Thus, there may be a reciprocal relationship between depression and multiple re-hospitalizations. This study will be the first to investigate both sides of this relationship, and to examine the impact of depression on the long-term risk of multiple re-hospitalizations instead of focusing more narrowly on the short-term risk of the first re-hospitalization. The primary aim is to test the hypothesis that depression is an independent predictor of recurrent hospitalizations and mortality in patients with heart failure. The secondary aim is to test the hypothesis that multiple hospitalizations predict persistent or worsening depression in patients with HF. Additional aims include investigating whether depression helps to explain the disproportionately high rate of HF re-hospitalizations in African-American patients, and identifying mediators of the relationship between depression and re-hospitalization. A cohort of 400 adult patients (200 African-American, 200 white) with HF will be enrolled in the study and followed for 2 years after their index hospitalization at a large, urban teaching hospital in St. Louis. At enrollment, a structured interview to diagnose DSM-5 depressive disorders will be administered along with questionnaires to assess the severity of depression, anxiety, perceived stress, social support, HF self-care, and HF-related functional impairment. Data on prior HF hospitalizations, HF severity measures, comorbidities, and medications will be extracted from the electronic medical record (EMR) system. The depression questionnaire will be repeated every 3 months for 2 years. Hospitalizations and deaths will be ascertained by queries of the hospital's EMR system, interviews with the participants and collateral informants, medical records of admissions to other facilities, and the National Death Index. State-of-the-art methods for modeling recurrent events data will be used to analyze the time-dependent effect of depression on the rate of re-hospitalization and to determine whether it has more severe effects in African-American than in white patients. A linear mixed model will be used to evaluate the impact of multiple re-hospitalizations on the longitudinal course of depression. The findings will clarify the relationshp between depression and re-hospitalization in patients with heart failure, and help to identify novel targets for intervention.

描述（由申请人提供）：心力衰竭（HF）是老年人住院治疗的主要原因。多次再住院（其中许多是可以预防的）在心衰中很常见，并大大增加了疾病的累积负担和护理费用。非裔美国人HF再住院率高于白人患者，原因尚不清楚。目前的心衰再入院风险预测模型不完善，再住院预防工作效果不佳。需要对HF再住院的新危险因素进行研究。抑郁症是进一步研究的最佳候选者之一。这是心衰的常见合并症，初步证据表明它可能增加再住院率。此外，心衰的进展和多次再住院可能导致抑郁症的持续或恶化。因此，抑郁症与多次再住院之间可能存在相互关系。这项研究将首次调查这两方面的关系，并检查抑郁症对多次再次住院的长期风险的影响，而不是更狭隘地关注第一次再次住院的短期风险。主要目的是验证抑郁是心衰患者反复住院和死亡率的独立预测因子的假设。第二个目的是检验多重假设