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首页> 外文期刊>Journal of cardiac failure >Depression predicts repeated heart failure hospitalizations
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Depression predicts repeated heart failure hospitalizations

机译：抑郁症预示着反复的心力衰竭住院

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Objective: Management of depression, if it is independently associated with repeated hospitalizations for heart failure (HF), offers promise as a viable and cost-effective strategy to improve health outcomes and reduce health care costs for HF. The objective of this study was to assess the association between depression and the number of HF-related hospitalizations in patients with low-to-moderate systolic or diastolic dysfunction, after controlling for illness severity, socioeconomic factors, physician adherence to evidence-based medications, patient adherence to HF drug therapy, and patient adherence to salt restrictions. Methods and Results: The Heart Failure Adherence and Retention Trial (HART) was a randomized behavioral trial to evaluate whether patient self-management skills coupled with HF education improved patient outcomes. Depression was measured at baseline with the Geriatric Depression Scale (GDS). The number of hospitalizations was analyzed with a negative binomial regression model that included an offset term to account for the differential duration of follow-up for individual subjects. The average unadjusted number of hospitalizations per year was 0.40 in the depressed group (GDS ≥10) and 0.33 in the nondepressed group (GDS <10). Depression was a strong predictor (incident rate ratio 1.45; P =.006) after adjusting for physician adherence to evidence-based medication use, patient adherence to HF drug therapy, patient adherence to salt restriction, illness severity, HF severity (6-minute walk <620 feet), and socioeconomic factors. Conclusions: Depression is a strong psychosocial predictor of repeated hospitalizations for HF. Compared with nondepressed individuals, those with depression were hospitalized for HF 1.45 times more often, even after controlling for physician adherence to evidence-based medications and patient adherence to HF drug therapy and salt restrictions. This finding suggests that clinicians should screen for depression early in the course of HF management.
机译：目的：抑郁症的治疗，如果与心力衰竭（HF）的反复住院独立存在，则有望成为一种可行且具有成本效益的策略，以改善HF的健康结果并降低医疗保健成本。这项研究的目的是，在控制疾病的严重程度，社会经济因素，医师对循证药物的依从性，控制因素后，评估抑郁症与低至中​​度收缩或舒张功能不全患者的抑郁症与住​​院相关的HF次数之间的关系。病人坚持使用HF药物治疗，以及病人遵守盐分限制。方法和结果：心衰坚持和保留试验（HART）是一项随机行为试验，旨在评估患者的自我管理技能和HF教育是否能改善患者的预后。在基线时用老年抑郁量表（GDS）测量抑郁。用负二项式回归模型分析住院次数，该模型包括一个补偿项，以说明个体受试者随访的持续时间。抑郁组（GDS≥10）每年平均未经调整的住院次数为0.40，非抑郁组（GDS <10）每年为0.33。调整医师对循证用药的依从性，患者对HF药物治疗的依从性，患者对盐分限制的依从性，疾病严重度，HF严重性（6分钟）后，抑郁症是一个强有力的预测指标（发生率比1.45; P = .006）步行<620英尺）以及社会经济因素。结论：抑郁症是心衰反复住院的强烈社会心理预测指标。与未患抑郁症的人相比，即使在控制医师对循证药物的依从性以及患者对HF药物治疗和食盐限制的依从性之后，抑郁症患者的HF住院频率也高出1.45倍。这一发现表明临床医生应在HF管理的早期筛查抑郁症。

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