Associations Between Depressive Symptoms and HFpEF-Related Outcomes.,JACC: Heart Failure

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Associations Between Depressive Symptoms and HFpEF-Related Outcomes.
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2020-09-09 , DOI: 10.1016/j.jchf.2020.06.010
Alvin Chandra ₁ , Michael A D Alcala ₂ , Brian Claggett ₃ , Akshay S Desai ₃ , James C Fang ₄ , John F Heitner ₅ , Jiankang Liu ₃ , Bertram Pitt ₆ , Scott D Solomon ₃ , Marc A Pfeffer ₃ , Eldrin F Lewis ₇

Affiliation

Objectives

This study analyzed changes in depressive symptoms in patients with heart failure and preserved ejection fraction (HFpEF) who were enrolled in the TOPCAT (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function) trial.

Background

There are limited longitudinal data for depressive symptoms in patients with HFpEF.

Methods

In patients enrolled in the United States and Canada (n = 1,431), depressive symptoms were measured using Patient Health Questionnaire-9 (PHQ-9). Clinically meaningful changes in PHQ-9 scores were defined as worse (≥3-point increase) or better (≥3-point decrease). Multivariate models were used to identify predictors of change in depressive symptoms. Cox proportional hazard models were used to determine the impact of symptom changes from baseline on subsequent incident cardiovascular events.

Results

At 12 months, 19% of patients experienced clinically worsening depressive symptoms, 31% better, and 49% unchanged. Independent predictors of clinically meaningful improvement in depressive symptoms included higher baseline PHQ-9 scores, male sex, lack of chronic obstructive pulmonary disease, and randomization to spironolactone. After data were adjusted for cardiovascular comorbidities, higher baseline PHQ-9 was associated with all-cause mortality (hazard ratio [HR]: 1.09; 95% confidence interval [CI]: 1.02 to 1.16; p = 0.011), whereas worsening depressive symptoms at 12 months were associated with cardiovascular death (HR: 2.47; 95% CI: 1.32 to 4.63; p = 0.005) and all-cause mortality (HR: 1.82; 95% CI: 1.13 to 2.93; p = 0.014). Randomization to spironolactone was associated with modest but statistically significant reduction in depressive symptoms over the course of the trial (p = 0.014).

Conclusions

Higher baseline depressive symptoms and worsening depressive symptoms were associated with all-cause mortality. Randomization to spironolactone was associated with modest reduction in depressive symptoms. (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; NCT00094302)

中文翻译：

抑郁症状与 HFpEF 相关结果之间的关联。

目标

本研究分析了参加 TOPCAT（心力衰竭和收缩功能保留的成人的醛固酮拮抗剂治疗）试验的心力衰竭和射血分数保留（HFpEF）患者抑郁症状的变化。

背景

HFpEF 患者抑郁症状的纵向数据有限。

方法

在美国和加拿大（n = 1,431）的患者中，使用患者健康问卷 9 (PHQ-9) 测量抑郁症状。PHQ-9 评分有临床意义的变化被定义为更差（增加≥3 分）或更好（减少≥3 分）。使用多变量模型来确定抑郁症状变化的预测因素。Cox 比例风险模型用于确定从基线开始的症状变化对后续心血管事件的影响。

结果

在 12 个月时，19% 的患者出现临床抑郁症状恶化，31% 好转，49% 没有变化。抑郁症状有临床意义改善的独立预测因素包括较高的基线 PHQ-9 评分、男性、无慢性阻塞性肺疾病和随机服用螺内酯。在针对心血管合并症调整数据后，较高的基线 PHQ-9 与全因死亡率相关（风险比 [HR]：1.09；95% 置信区间 [CI]：1.02 至 1.16；p = 0.011），而抑郁症状恶化12 个月时与心血管死亡（HR：2.47；95% CI：1.32 至 4.63；p = 0.005）和全因死亡率（HR：1.82；95% CI：1.13 至 2.93；p = 0.014）相关。