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首页> 外文期刊>BMC Psychiatry >Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study
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Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study

机译：老年冠心病患者冠状动脉介入治疗后抑郁症状和功能下降：一项前瞻性队列研究

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Background Depressive symptoms are prevalent in patients with coronary artery disease (CAD). It is unclear, however, how depressive symptoms change over time and the impact of these changes on long-term functional outcomes. We examined the association between different trajectories of depressive symptoms over 1?year and change in functional status over 30?months among patients undergoing coronary angiography. Methods This was a prospective cohort study of 350 patients aged 60 and older undergoing non-emergent cardiac catheterization (October 2003–February 2007). A dynamic measure of significant depressive symptoms (i.e., Geriatric Depression Scale score 5+) capturing change over 12?months was derived that categorized patients into the following groups: (i) no clinically important depressive symptoms (at baseline, 6 and 12?months); (ii) baseline-only symptoms (at baseline but not at 6 and 12?months); (iii) new onset symptoms (not at baseline but present at either 6 or 12?months); and, (iv) persistent symptoms (at baseline and at either 6 or 12?month assessment). Primary outcomes were mean change in Older Americans Resources and Services (OARS) instrumental (IADL) and basic activities of daily living (BADL) scores (range 0–14 for each) across baseline (pre-procedure) and 6, 12, and 30?months post-procedure visits. Results Estimates for the symptom categories were 71?% (none), 9?% (baseline only), 8?% (new onset) and 12?% (persistent). In adjusted models, patients with persistent symptoms showed a significant decrease in mean IADL and BADL scores from baseline to 6?months (?1.32 [95?% CI ?1.78 to ?0.86] and ?0.63 [?0.97 to ?0.30], respectively) and from 12 to 30?months (?0.79 [?1.27 to ?0.31] and ?1.00 [?1.35 to ?0.65], respectively). New onset symptoms were associated with a significant decrease in mean IADL scores at 6?months and from 6 to 12?months. Patients with no depressive symptoms showed little change in scores whereas those with baseline only symptoms showed significant improvement in mean IADL at 6?months. Conclusions Patients with persistent depressive symptoms were at greatest risk for worse functional status 30?months following coronary interventions. Proactive screening and follow-up for depression in this population offers prognostic value and may facilitate the implementation of targeted interventions.
机译：背景技术抑郁症状在冠心病（CAD）患者中普遍存在。然而，目前尚不清楚抑郁症状如何随时间变化以及这些变化对长期功能结局的影响。我们研究了接受冠状动脉造影的患者在1年以上的不同抑郁症状轨迹与30个月以上的功能状态变化之间的关联。方法这是一项前瞻性队列研究，研究对象为350名60岁及以上的患者，他们接受了非紧急心脏导管插入术（2003年10月至2007年2月）。得出了在12个月内捕获变化的重大抑郁症状（即老年抑郁量表得分5+）的动态度量，将患者分为以下几类：（i）没有临床上重要的抑郁症状（在基线，6和12个月时） ）; （ii）仅基线症状（在基线但不在6和12个月时出现）; （iii）新的发作症状（不在基线，而是在6或12个月时出现）; （iv）持续症状（在基线以及在6或12个月评估时）。主要结果是在基线（术前），6、12和30期间，美国老年人资源和服务（OARS）工具（IADL）和日常生活基本活动（BADL）得分（每个范围为0–14）的平均变化。几个月的手术后访问。结果症状类别的估计值为71％（无），9％（仅基线），8％（新发）和12％（持续）。在调整后的模型中，具有持续症状的患者显示平均IADL和BADL分数从基线到6个月显着下降（分别为1.32 [95％CI CI 1.78至0.86]和0.63 [0.97至0.30]] ）和12到30个月（分别为0.79 [1.27至0.31]和1.00 [1.35至0.65]）。新发症状与6个月和6到12个月的IADL平均得分显着降低有关。没有抑郁症状的患者得分变化不大，而仅有基线症状的患者在6个月时平均IADL显着改善。结论患有持续性抑郁症状的患者在进行冠状动脉介入治疗后30个月内，其功能状态恶化的风险最大。对该人群进行抑郁症的主动筛查和随访可提供预后价值，并可促进有针对性的干预措施的实施。

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