作者：Laurie Barclay, MD
出處：WebMD醫學新聞
April 16, 2009 — 根據4月21日美國心臟學院期刊的一篇世代研究報告，在冠狀動脈疾病(coronary artery disease，CAD)診斷之後，不論有無抗憂鬱藥物(antidepressant medication，ADM)治療，憂鬱與心衰竭(heart failure，HF)發生率有關。
猶他州Intermountain醫學中心的Heidi T. May博士等人寫道，憂鬱是CAD病患預後不佳的一個風險因素；不過，對於CAD病患之HF對憂鬱的影響所知有限。
研究目標在於檢視CAD診斷之後，HF發生率對憂鬱的影響。研究樣本包括13,708名沒有國際疾病分類碼第九版診斷為HF和憂鬱的病患，在診斷有CAD(定義為至少70%的狹窄)時，也未處方有ADM。在7,719名有醫療紀錄的病患中，根據使用的ADM對於後來的憂鬱診斷進行分類。
追蹤病患直到醫師診斷或國際疾病分類碼第九版診斷為HF或死亡，使用Cox比例風險迴歸模型分析資料。
診斷CAD之後，有1,377名病患(10.0%)診斷有臨床憂鬱，這些病患的HF發生率是16.4%，而不是CAD診斷者，之後有憂鬱者的HF發生率則是3.6%。有憂鬱者的 HF發生率增加(校正風險比[HR]為1.50；P<.0001)。有關藥物使用的現有追蹤資料中，也有類似的發現。相較於沒有憂鬱者，未使用ADM之憂鬱者的HR為1.68 (P<.0001)，使用ADM者的憂鬱HR為2.00 (P<.0001)。憂鬱病患有無使用ADM者之間的 HF發生率沒有差異(HR, 0.84；P=.24)。
研究作者寫道，憂鬱診斷顯示與CAD診斷後的HF發生率增加有關，與ADM治療無關；需要後續研究，以確認CAD病患憂鬱與HF的關聯。
研究限制包括可能有其他干擾因素、不是隨機設計、無法確認因果與暫時性關係、病患取樣、僅住院病患有確認HF診斷。
研究作者結論表示，因為HF和憂鬱兩者是最引人困擾的疾病之一，且與健康照護的高利用率與日常功能的嚴重限制有關，本研究對此兩種疾病關聯的發現可以增加健康照護服務的使用，因而增加資源與費用。雖然此一關聯還有待後續研究，其對於發病率、死亡率、生活品質、健康照護花費等公共衛生議題有顯著影響。
研究作者宣告沒有相關財務關係。
Depression Linked to Heart Failure After Diagnosis of Coronary Artery Disease
By Laurie Barclay, MD
Medscape Medical News
April 16, 2009 — Depression is linked to increased incidence of heart failure (HF) after diagnosis of coronary artery disease (CAD), regardless of antidepressant medication (ADM) treatment, according to the results of a cohort study reported in the April 21 issue of the Journal of the American College of Cardiology.
"Depression has been shown to be a risk factor for poor outcomes among CAD patients," write Heidi T. May, PhD, MSPH, from the Intermountain Medical Center in Murray, Utah, and colleagues. "However, little is known about the influence of depression on HF development in CAD patients."
The goal of this study was to examine the effect of post-CAD diagnosis of depression on the incidence of HF. The study sample consisted of 13,708 patients without International Classification of Diseases, Ninth Revision, diagnoses of HF and depression who were not prescribed ADM at the time of CAD diagnosis, defined as at least 70% stenosis. Among 7719?patients with available medication records, those subsequently diagnosed with depression were stratified by use of ADM.
Patients were followed up until clinician diagnosis or International Classification of Diseases, Ninth Revision, code diagnosis of HF or death, and data were analyzed with Cox proportional hazards regression models.
Clinical depression was diagnosed in 1377 patients (10.0%) after diagnosis of CAD. HF incidence in these patients was 16.4 per 100 vs 3.6 per 100 for those without a post-CAD diagnosis of depression. The risk for HF incidence was increased in those with depression (adjusted hazard ratio [HR], 1.50; P?P?P?P?=?.24).
"Depression diagnosis was shown to be associated with an increased incidence of HF after CAD diagnosis, regardless of ADM treatment," the study authors write. "This finding suggests the need to further study the effect of depression on HF risk among CAD patients."
Limitations of this study include possible residual confounding, nonrandomized design, inability to determine causality and temporality, patient selection, and determination of HF diagnosis only in hospitalized patients.
"Because both HF and depression are some of the most burdensome diseases in the world and are associated with high rates of health care utilization and severe limitations in daily functioning, this study's finding of an association between these 2 diseases could increase use of health care services, thus multiplying the burden via resources and cost," the study authors conclude. "Although this association needs further investigation, its consequences and future interventions could have a significant public health impact through the reduction of morbidity, mortality, quality of life, and health care expenditures."
The study authors have disclosed no relevant financial relationships.
J Am Coll Cardiol. 2009;53:1440-1447. |
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