DEPRESSION AND REHOSPITALIZATION IN PATIENTS WITH HEART FAILURE

心力衰竭患者的抑郁和再住院

• 批准号: 9231483
• 负责人: KENNETH E FREEDLAND
• 金额: $ 69.85万
• 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/9231483
• 关键词: Address; Admission activity; Adult; Affect; Affordable Care Act; African American; American; Anxiety; Caring; Cessation of life; Comorbidity; Computerized Medical Record; DSM-V; Data; Depressive disorder; Diagnosis; Elderly; Enrollment; Event; Fostering; Frequencies; Heart Rate; Heart failure; Hospitalization; Hospitals; Intervention; Interview; Investigation; Life; Measures; Mediator of activation protein; Medical; Medical Records; Mental Depression; Methods; Modeling; Participant; Patients; Pharmaceutical Preparations; Predictive Value; 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; cost; depressed patient; functional decline; functional disability; indexing; informant; longitudinal course; meetings; mortality; novel; patient population; predictive modeling; pressure; programs; public health relevance

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）是老年人住院的主要原因。多次再住院（其中许多是可以预防的）在HF中很常见，并大大增加了累积的疾病负担和护理费用。非裔美国人的HF再住院率高于白色患者，原因尚不清楚。目前HF再入院风险预测模型不足，再住院预防措施无效。需要研究HF再住院的新风险因素。抑郁症是进一步研究的最佳候选人之一。它是HF中的一种常见合并症，初步证据表明它可能会增加再住院率。此外，HF的进展和多次再住院可能导致抑郁症的持续或恶化。因此，抑郁症和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种关系的双方，并研究抑郁症对多次再住院的长期风险的影响，而不是更狭隘地关注首次再住院的短期风险。本研究的主要目的是检验抑郁是心力衰竭患者复发住院和死亡率的独立预测因子这一假设。第二个目的是检验多个假设， 住院治疗预示HF患者抑郁持续或恶化。其他目的包括调查抑郁症是否有助于解释非裔美国人患者HF再住院率不成比例的高，并确定抑郁症和再住院之间关系的介导因素。400例HF成人患者（200例非裔美国人，200例白色）将入组研究，并在圣路易斯的一家大型城市教学医院首次住院后随访2年。在注册时， 诊断DSM-5抑郁障碍的访谈将与问卷一起进行沿着，以评估抑郁、焦虑、感知压力、社会支持、HF自我护理和HF相关功能障碍的严重程度。将从电子病历（EMR）系统中提取关于既往HF住院、HF严重程度指标、合并症和药物治疗的数据。抑郁问卷将每3个月重复一次，持续2年。住院和死亡将通过查询医院的EMR系统、与参与者和间接线人的访谈、其他设施的入院医疗记录和国家死亡指数来确定。将采用最先进的复发事件数据建模方法分析抑郁症对再住院率的时间依赖性影响，并确定其对非洲裔美国人的影响是否比白色患者更严重。将使用线性混合模型来评估多次再住院对抑郁症纵向病程的影响。这些发现将阐明心力衰竭患者抑郁与再住院之间的关系，并有助于确定新的干预目标。