Fuwei Xing, Min Gao, Yuzhong Wu, Weihao Liang, Jingzhou Jiang, Yu-Gang Dong, Yi Li, Bin Dong, Chen Liu
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Individual trajectory patterns based on PHQ-9 scores during the first 3 years were identified using latent class trajectory models, and their associations with clinical outcomes were evaluated using Cox regression models.</p><p><strong>Results: </strong>Among the 609 participants, 316 (51.9%) were female, with a median age of 74 years (IQR: 66, 80). Four distinct depression trajectory patterns were identified: low (consistently low scores; 349, 57.3%), mild (sustained mild elevation; 110, 18.1%), high (sustained moderate-severe elevation; 52, 8.5%) and recurrent deterioration (high baseline scores, remission, then escalation; 98, 16.1%). According to the multivariate Cox model, recurrent deterioration was associated with a significantly greater risk of all-cause mortality (HR: 2.05; 95% CI 1.16, 3.64) than the low trajectory pattern. No significant differences were found among the low, mild and high trajectory groups.</p><p><strong>Conclusions: </strong>Four distinct depression trajectory patterns were identified among patients with HFpEF. Notably, patients who experienced a recurrent deterioration trajectory presented a significantly increased risk of all-cause mortality. 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引用次数: 0
摘要
背景:心力衰竭患者抑郁症状的长期模式,特别是那些保留射血分数(HFpEF)的患者,及其与预后的关系尚未得到很好的研究。方法:本分析包括来自TOPCAT(用醛固酮拮抗剂治疗保留心功能心力衰竭)试验的609名参与者。采用患者健康问卷-9 (PHQ-9)在基线、1年、2年和3年的间隔对抑郁症状进行评估。基于前3年PHQ-9评分的个体轨迹模式使用潜在类别轨迹模型确定,并使用Cox回归模型评估其与临床结果的相关性。结果:609名参与者中,女性316名(51.9%),中位年龄为74岁(IQR: 66,80)。发现了四种不同的抑郁轨迹模式:低(持续低得分;349例,57.3%),轻度(持续轻度升高;110, 18.1%),高(持续中重度升高;52,8.5%)和复发性恶化(高基线评分,缓解,然后升级;98年,16.1%)。根据多变量Cox模型,复发性恶化与全因死亡风险显著升高相关(HR: 2.05;95% CI 1.16, 3.64)高于低轨迹模式。低、轻、高轨迹组间无显著差异。结论:HFpEF患者有四种不同的抑郁轨迹模式。值得注意的是,经历复发性恶化轨迹的患者呈现出明显增加的全因死亡率风险。我们的研究结果强调了长期监测患者抑郁症状的重要性,而不是专注于单个时间点。试验注册号:NCT00094302。
Influence of depression trajectories in heart failure patients with preserved ejection fractions: a secondary analysis of adverse outcomes in the TOPCAT trial.
Background: Long-term patterns of depressive symptoms among patients with heart failure, specifically those with a preserved ejection fraction (HFpEF), and their relationship with prognoses are not well studied.
Methods: This analysis included 609 participants from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at baseline and at 1-year, 2-year and 3-year intervals. Individual trajectory patterns based on PHQ-9 scores during the first 3 years were identified using latent class trajectory models, and their associations with clinical outcomes were evaluated using Cox regression models.
Results: Among the 609 participants, 316 (51.9%) were female, with a median age of 74 years (IQR: 66, 80). Four distinct depression trajectory patterns were identified: low (consistently low scores; 349, 57.3%), mild (sustained mild elevation; 110, 18.1%), high (sustained moderate-severe elevation; 52, 8.5%) and recurrent deterioration (high baseline scores, remission, then escalation; 98, 16.1%). According to the multivariate Cox model, recurrent deterioration was associated with a significantly greater risk of all-cause mortality (HR: 2.05; 95% CI 1.16, 3.64) than the low trajectory pattern. No significant differences were found among the low, mild and high trajectory groups.
Conclusions: Four distinct depression trajectory patterns were identified among patients with HFpEF. Notably, patients who experienced a recurrent deterioration trajectory presented a significantly increased risk of all-cause mortality. Our findings highlight the importance of monitoring patients' depressive symptoms over time rather than focusing on a single timepoint.
期刊介绍:
Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.