The Impact of Depression on Outcomes in Patients With Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial
The Impact of Depression on Outcomes in Patients With Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial
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DOI：
10.1016/j.cardfail.2021.06.008
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发表时间：
2021-12-01
影响因子：
6
通讯作者：
Ahmad, Tariq
中科院分区：
文献类型：
--
作者：
Chouairi, Fouad;Fuery, Michael A.;Ahmad, Tariq
背景：目前尚不清楚为什么抑郁症与心力衰竭（HF）患者的不良结局相关。我们研究与射血分数降低的心衰患者与指南指导的药物治疗（GDMT）管理的抑郁症和临床结局之间的关系：方法和结果：使用的GUIDE-IT试验，894例I IF与射血分数降低患者根据抑郁症的历史进行分层，和考克斯比例风险回归模型被用来检查与结果的关联。在整个队列中有140名患者（16%）患有抑郁症。他们往往是女性（29%对46%）。P <0.001）和白色（67%对53%，P= 0.002）。基线或90天时GDMT率无差异：90天时这些治疗达到的目标剂量也无差异（NS，所有）。所有时间点的氨基末端B型利钠肽前体水平在队列间相似（P > 0.05）。调整后，抑郁症与全因住院（风险比，1.42，95%置信区间1.11-1.81，P <0.01），心血管死亡（风险比，1.69，95%置信区间1.07-2.68，P <0.01），P = 0.025）和全因死亡率（风险比，1.54，95%可信区间1.03-2.32，P = 0.039）。结论：无论GDMT强度和氨基末端B型利钠肽前体水平如何，抑郁都会影响HF的临床结局。这一发现强调了在这些患者中实现最佳GDMT的同时关注心理健康的必要性。
Background: It remains unclear why depression is associated with adverse outcomes in patients with heart failure (HF). We examine the relationship between depression and clinical outcomes among patients with HF with reduced ejection fraction managed with guideline-directed medical therapy (GDMT).Methods and Results: Using the GUIDE-IT trial, 894 patients with I IF with reduced ejection fraction were stratified according to a history of depression, and Cox proportional hazards regression modeling was used to examine the association with outcomes. There were 140 patients (16%) in the overall cohort who had depression. They tended to be female (29% vs 46%. P < .001) and White (67% vs 53%, P= .002). There were no differences in GDMT rates at baseline or at 90 days: nor were there differences in target doses of these therapies achieved at 90 days (NS, all). amino-terminal pro-B-type natriuretic peptide levels at all time points were similar between the cohorts ( P > .05, all). After adjustment, depression was associated with all-cause hospitalizations (hazard ratio, 1.42, 95% confidence interval 1.11-1.81, P < .01), cardiovascular death (hazard ratio, 1.69, 95% confidence interval 1.07-2.68. P = .025), and all-cause mortality (hazard ratio, 1.54, 95% confidence interval 1.03-2.32, P = .039).Conclusions: Depression impacts clinical outcomes in HF regardless of GDMT intensity and amino-terminal pro-B-type natriuretic peptide levels. This finding underscores the need for a focus on mental health in parallel to achievement of optimal GDMT in these patients.