DEPRESSION AND REHOSPITALIZATION IN PATIENTS WITH HEART FAILURE

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，在心力衰竭中很常见，并极大地增加了疾病的累积负担和护理费用。非裔美国人的心力衰竭再住院率高于白人患者，原因尚不清楚。目前的心力衰竭再入院风险预测模型不完善，再入院预防措施不力。需要对心衰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对象之一。这是心力衰竭的一种普遍的共病，初步证据表明，它可能会增加再住院率。此外，心力衰竭的进展和多次再住院可能会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作用的关系。这项研究将首次调查这种关系的两个方面，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首次再次住院的短期风险。主要目的是检验抑郁是心力衰竭患者反复住院和死亡率的独立预测因素的假设。第二个目的是检验这样的假设 住院预测心力衰竭患者持续或恶化的抑郁。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心力衰竭再住院率高得不成比例的原因，以及确定抑郁症与再住院之间关系的中介因素。400名成年心力衰竭患者(200名非裔美国人，200名白人)将参加这项研究，并在圣路易斯一家大型城市教学医院指数住院后进行为期2年的跟踪调查。在注册时，结构化的 诊断DSM-5抑郁障碍的访谈将与问卷一起进行，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)系统中提取有关先前的心力衰竭住院、心力衰竭严重程度测量、合并症和药物的数据。抑郁问卷每3个月重复一次，为期2年。住院和死亡将通过询问医院的EMR系统、与参与者和附带告密者的面谈、其他设施的住院医疗记录和国家死亡指数来确定。将使用最先进的方法对复发事件数据进行建模，以分析抑郁症对再住院率的时间依赖性影响，并确定它在非裔美国人中的影响是否比白人患者更严重。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。这些发现将澄清心力衰竭患者抑郁和再次住院之间的关系，并有助于确定新的干预目标。

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.