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Sandek A, Edelmann F, Gertler C, Friede T, Wachter R, Hasenfuß G. Transition from asymptomatic to symptomatic systolic chronic heart failure: rationale and design of TransitionCHF. ESC Heart Fail 2024; 11:2366-2378. [PMID: 38606543 PMCID: PMC11287358 DOI: 10.1002/ehf2.14783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/05/2024] [Accepted: 03/16/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Chronic systolic heart failure (CHF) is a major health burden. A relevant number of patients shows asymptomatic left ventricular dysfunction (ALVSD) before symptomatic CHF or becomes asymptomatic after initiating heart failure therapy. Clinical course, prognosis, and response to pharmacological and device-based treatment are largely unknown in these two distinct groups of patients. Current pharmacological and interventional therapies do neither properly address the underlying pathophysiology nor prevent malignant loss of function. New therapeutic paradigms are needed to stop the progression from asymptomatic to symptomatic heart failure. Key questions are what causes progression of clinically asymptomatic New York Heart Association (NYHA) I heart failure to overt heart failure (>NYHA I) in some but not all patients and the underlying reasons for this transition. This requires the identification of disease mechanisms and biomarkers that predict outcome in well-defined cohorts for innovative preclinical and clinical trials. METHODS AND RESULTS TransitionCHF is a prospective, multicentre, longitudinal pathophysiological evaluation cohort study in patients with asymptomatic systolic dysfunction NYHA I and left ventricular ejection fraction ≤40%. The cohort comprises both incidental findings and patients who had become asymptomatic after a previous symptomatic event. TransitionCHF has recruited 1000 patients with ALVSD caused by various aetiologies in 20 university heart failure clinics across Germany. Both patients with and without comorbidities at study entry will be recruited. Patients will be systematically investigated and followed up annually over the course of the study. The primary composite endpoint is time to hospitalization for heart failure and cardiovascular death. The secondary endpoints assess time to all-cause mortality, to cardiovascular mortality, to heart failure mortality, to all-cause hospitalization, to heart failure hospitalization, and to recurrent heart failure hospitalizations, as well as time to assist device implantation/transplantation. Additional investigations focusing on biomarkers, comorbidities, gender aspects, nutrition, and functional parameters including quality of life will be performed. CONCLUSIONS TransitionCHF will provide a more thorough pathophysiological understanding of the progression of asymptomatic systolic dysfunction into symptomatic heart failure that will help develop therapies tailored to prevent progressive heart failure.
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Affiliation(s)
- Anja Sandek
- Clinic for Cardiology and Pneumology, Heart Research CenterUniversity Medical Center GöttingenRobert‐Koch‐Str. 4037075GöttingenGermany
- German Centre for Cardiovascular Research (DZHK)GöttingenGermany
| | - Frank Edelmann
- Department of Internal Medicine and CardiologyGerman Heart Center Charité, Charité—University Medicine BerlinBerlinGermany
- German Centre for Cardiovascular Research (DZHK)BerlinGermany
| | - Christoph Gertler
- Clinic for Cardiology and Pneumology, Heart Research CenterUniversity Medical Center GöttingenRobert‐Koch‐Str. 4037075GöttingenGermany
- German Centre for Cardiovascular Research (DZHK)GöttingenGermany
| | - Tim Friede
- German Centre for Cardiovascular Research (DZHK)GöttingenGermany
- Department of Medical StatisticsUniversity Medical Center GöttingenGöttingenGermany
| | - Rolf Wachter
- Clinic for Cardiology and Pneumology, Heart Research CenterUniversity Medical Center GöttingenRobert‐Koch‐Str. 4037075GöttingenGermany
- German Centre for Cardiovascular Research (DZHK)GöttingenGermany
- Clinic and Policlinic for CardiologyUniversity Hospital LeipzigLeipzigGermany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Heart Research CenterUniversity Medical Center GöttingenRobert‐Koch‐Str. 4037075GöttingenGermany
- German Centre for Cardiovascular Research (DZHK)GöttingenGermany
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Jiang H, Hu R, Wang YJ, Xie X. Predicting depression in patients with heart failure based on a stacking model. World J Clin Cases 2024; 12:4661-4672. [PMID: 39070824 PMCID: PMC11235518 DOI: 10.12998/wjcc.v12.i21.4661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/27/2024] [Accepted: 06/17/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND There is a lack of literature discussing the utilization of the stacking ensemble algorithm for predicting depression in patients with heart failure (HF). AIM To create a stacking model for predicting depression in patients with HF. METHODS This study analyzed data on 1084 HF patients from the National Health and Nutrition Examination Survey database spanning from 2005 to 2018. Through univariate analysis and the use of an artificial neural network algorithm, predictors significantly linked to depression were identified. These predictors were utilized to create a stacking model employing tree-based learners. The performances of both the individual models and the stacking model were assessed by using the test dataset. Furthermore, the SHapley additive exPlanations (SHAP) model was applied to interpret the stacking model. RESULTS The models included five predictors. Among these models, the stacking model demonstrated the highest performance, achieving an area under the curve of 0.77 (95%CI: 0.71-0.84), a sensitivity of 0.71, and a specificity of 0.68. The calibration curve supported the reliability of the models, and decision curve analysis confirmed their clinical value. The SHAP plot demonstrated that age had the most significant impact on the stacking model's output. CONCLUSION The stacking model demonstrated strong predictive performance. Clinicians can utilize this model to identify high-risk depression patients with HF, thus enabling early provision of psychological interventions.
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Affiliation(s)
- Hui Jiang
- Department of Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Rui Hu
- Department of Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Yu-Jie Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Xiang Xie
- Department of Ultrasound Diagnosis, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
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Zhang L, Wang W, Peng Y, He G, Ji R, Lei L, Li J, Pu B, Liu Y, Yu Y, Zhang H. Associations of cumulative depressive symptoms within 1-year of discharge with subsequent mortality among patients hospitalized for acute heart failure: Findings from The China PEACE Prospective Heart Failure Study. J Affect Disord 2024; 351:299-308. [PMID: 38290578 DOI: 10.1016/j.jad.2024.01.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND To examine the associations between cumulative depressive symptoms and subsequent mortality among patients hospitalized for acute hear failure (AHF). METHODS By using data from a prospective cohort study of patients with HF, depressive symptoms were measured by using Patient Health Questionnaire-2 (PHQ-2) at admission, 1-and 12-month after discharge. Cumulative depressive symptoms were interpreted by cumulative PHQ-2 score and cumulative times of depressive symptoms. Outcomes included subsequent 3-year all-cause and cardiovascular mortality. RESULTS We included 2347 patients with the median follow-up of 4.4 (interquartile range [IQR]: 4.0-5.0) years. Tertile 3 of cumulative PHQ-2 score had the highest risk of all-cause (hazard ratio [HR]: 1.47, 95 % confidence interval [CI]: 1.21-1.78) and cardiovascular mortality (HR: 1.51, 95 % CI: 1.21-1.89) compared with Tertile 1; patients with≥2 times of depressive symptoms had the highest risk of all-cause (HR: 1.62, 95 % CI: 1.31-2.00) and cardiovascular mortality (HR: 1.60, 95 % CI: 1.25-2.05) compared with patients without any depressive symptom. Cumulative PHQ-2 score provided the highest level of incremental prognostic ability in predicting the risk of all-cause (C-statistics: 0.64, 95 % CI: 0.62-0.66) and cardiovascular mortality (C-statistics: 0.65, 95 % CI: 0.62-0.67) on the basis of Get With The Guidelines-Heart Failure score. CONCLUSION Cumulative depressive symptoms were associated with the increased risk of subsequent mortality and provided incremental prognostic ability for the outcomes among patients with HF. Repeated depressive symptom measurements could be helpful to monitor long-term depressive symptoms, identify targeted patients and perform psychological interventions and social support to improve clinical outcomes among patients with AHF.
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Affiliation(s)
- Lihua Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Peng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangda He
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runqing Ji
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lubi Lei
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingkuo Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Boxuan Pu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanchen Liu
- National Clinical Research Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
| | - Yanwu Yu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haibo Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Zabielska P, Szkup M, Kotwas A, Skonieczna-Żydecka K, Karakiewicz B. Association between symptoms of depression and inflammatory parameters in people aged over 90 years. BMC Geriatr 2024; 24:317. [PMID: 38575920 PMCID: PMC10996151 DOI: 10.1186/s12877-024-04895-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/14/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Old age is a period of life that presents many health and social challenges, resulting in a greater vulnerability to the development of mental disorders, including depression. There has been a growing interest in the relationship between depression and inflammatory factors, because of its potential clinical and therapeutic implications. Inflammatory processes, which were originally understood as a response to infection and trauma, appear to play an important role in the pathogenesis of depression in the elderly. The aim of the study was to analyse the relationship between the severity of depressive disorders and inflammatory parameters in people over 90 years of age. METHODS The study was conducted in Poland in 2017. The study population consisted of long-lived individuals, both living at home and staying in residential care homes. The participants were 90 people of both sexes (69 women and 21 men), aged between 90 and 103 years (mean = 92.36; SD = 2.98). The study was conducted using the diagnostic survey method with a questionnaire technique. The Geriatric Depression Scale (GDS) was used to carry out the analysis. The levels of selected inflammatory factors were determined using relevant laboratory tests. RESULTS In the study group, the highest percentage of people had symptoms of moderate depression (n = 36;40%), followed by those without depression (n = 35;38.9%). There was a weak negative correlation between GDS scores and fibrinogen levels (p ≤ 0.05). The logistic regression model showed no significant relationship between inflammatory parameters and the development of depressive disorders. CONCLUSIONS Inflammatory parameters do not appear to predict the development of depressive disorders in people over 90 years of age.
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Affiliation(s)
- Paulina Zabielska
- Subdepartment of Social Medicine and Public Health, Department of Social Medicine, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210, Szczecin, Poland
| | - Małgorzata Szkup
- Department of Social Nursing, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210, Szczecin, Poland.
| | - Artur Kotwas
- Independent Research and Biostatistics Laboratory, Department of Social Medicine, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210, Szczecin, Poland
| | - Karolina Skonieczna-Żydecka
- Department of Biochemical Research, Pomeranian Medical University in Szczecin, Broniewskiego 24, 71-460, Szczecin, Poland
| | - Beata Karakiewicz
- Subdepartment of Social Medicine and Public Health, Department of Social Medicine, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210, Szczecin, Poland
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Veskovic J, Cvetkovic M, Tahirovic E, Zdravkovic M, Apostolovic S, Kosevic D, Loncar G, Obradovic D, Matic D, Ignjatovic A, Cvetkovic T, Posch MG, Radenovic S, Ristić AD, Dokic D, Milošević N, Panic N, Düngen HD. Depression, anxiety, and quality of life as predictors of rehospitalization in patients with chronic heart failure. BMC Cardiovasc Disord 2023; 23:525. [PMID: 37891464 PMCID: PMC10612261 DOI: 10.1186/s12872-023-03500-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Chronic heart failure (CHF) is a severe condition, often co-occurring with depression and anxiety, that strongly affects the quality of life (QoL) in some patients. Conversely, depressive and anxiety symptoms are associated with a 2-3 fold increase in mortality risk and were shown to act independently of typical risk factors in CHF progression. The aim of this study was to examine the impact of depression, anxiety, and QoL on the occurrence of rehospitalization within one year after discharge in CHF patients. METHODS 148 CHF patients were enrolled in a 10-center, prospective, observational study. All patients completed two questionnaires, the Hospital Anxiety and Depression Scale (HADS) and the Questionnaire Short Form Health Survey 36 (SF-36) at discharge timepoint. RESULTS It was found that demographic and clinical characteristics are not associated with rehospitalization. Still, the levels of depression correlated with gender (p ≤ 0.027) and marital status (p ≤ 0.001), while the anxiety values were dependent on the occurrence of chronic obstructive pulmonary disease (COPD). However, levels of depression (HADS-Depression) and anxiety (HADS-Anxiety) did not correlate with the risk of rehospitalization. Univariate logistic regression analysis results showed that rehospitalized patients had significantly lower levels of Bodily pain (BP, p = 0.014), Vitality (VT, p = 0.005), Social Functioning (SF, p = 0.007), and General Health (GH, p = 0.002). In the multivariate model, poor GH (OR 0.966, p = 0.005) remained a significant risk factor for rehospitalization, and poor General Health is singled out as the most reliable prognostic parameter for rehospitalization (AUC = 0.665, P = 0.002). CONCLUSION Taken together, our results suggest that QoL assessment complements clinical prognostic markers to identify CHF patients at high risk for adverse events. CLINICAL TRIAL REGISTRATION The study is registered under http://clinicaltrials.gov (NCT01501981, first posted on 30/12/2011), sponsored by Charité - Universitätsmedizin Berlin.
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Affiliation(s)
- Jovan Veskovic
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, 13353, Berlin, Germany.
- Scirent Clinical Research and Science, 13353, Berlin, Germany.
| | - Mina Cvetkovic
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, 13353, Berlin, Germany
| | - Elvis Tahirovic
- Scirent Clinical Research and Science, 13353, Berlin, Germany
| | - Marija Zdravkovic
- Department of Cardiology, Faculty of Medicine, University Clinical Hospital Center Bezanijska Kosa, University of Belgrade, Belgrade, 11000, Serbia
| | - Svetlana Apostolovic
- Department for Cardiovascular Diseases, Clinical Centre Niš, University of Niš, Niš, 18000, Serbia
| | - Dragana Kosevic
- Institute for Cardiovascular Diseases Dedinje, Department of Cardiology, Belgrade, 11000, Serbia
| | - Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, Department of Cardiology, Belgrade, 11000, Serbia
- Faculty of Medicine, Department of Cardiology, University of Belgrade, University Clinical Center of Serbia, Belgrade, 11000, Serbia
| | - Danilo Obradovic
- Heart Center of Leipzig, University of Leipzig, 04289, Leipzig, Germany
| | - Dragan Matic
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, 11000, Serbia
| | | | | | | | - Sara Radenovic
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, 13353, Berlin, Germany
| | - Arsen D Ristić
- Faculty of Medicine, Department of Cardiology, University of Belgrade, University Clinical Center of Serbia, Belgrade, 11000, Serbia
| | - Danilo Dokic
- Scirent Clinical Research and Science, 13353, Berlin, Germany
| | - Nenad Milošević
- Scirent Clinical Research and Science, 13353, Berlin, Germany
| | - Natasa Panic
- Scirent Clinical Research and Science, 13353, Berlin, Germany
| | - Hans-Dirk Düngen
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, 13353, Berlin, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 13353, Berlin, Germany.
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Zhao Z, Liu P, Jin J, Wang W. Effects of non-drug interventions on anxiety and depression in patients with heart failure: A systematic review based on Bayesian network meta-analysis. J Psychiatr Res 2023; 161:348-357. [PMID: 37004407 DOI: 10.1016/j.jpsychires.2023.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/12/2023] [Accepted: 02/28/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND To discuss the effect of non-drug interventions on anxiety and depression in patients with heart failure (HF) through Bayesian network meta-analysis. METHODS Relevant literature was searched from PubMed, Web of Science, Embase and Medline from database establishment to October 2022 by a computer. Next, a screening was performed on randomized controlled trials (RCTs) for the effect of non-drug interventions on anxiety and depression in HF patients, followed by a collection of the related data. This meta-analysis was conducted based on Bayesian network, and the statistical analysis was conducted using R4.2 software. RESULTS A total of 23 papers were enrolled into this study. The results of Bayesian network meta-analysis showed that compared with the control group and the structured video conferencing support (SVCS) group, telephone case management (TCM) could effectively reduce the anxiety and depression of HF patients. The ranking results revealed that TCM may be the most effective intervention to lower the risk of depression in HF patients, followed by Tai Chi Chuan and Chi Kung training (TCC) and structured telephone support (STS). CONCLUSION TCM is the most effective intervention to prevent HF patients from anxiety and depression.
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Affiliation(s)
- Zhiying Zhao
- Department of Geriatrics, Sichuan Provincial People's Hospital, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Peng Liu
- Department of Geriatrics, Sichuan Provincial People's Hospital, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Jing Jin
- Department of Geriatrics, Sichuan Provincial People's Hospital, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Wenyan Wang
- Department of Heart Failure Center, Sichuan Provincial People's Hospital, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
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Eisele M, Rakebrandt A, Boczor S, Blozik E, Träder JM, Störk S, Herrmann-Lingen C, Scherer M. The association of general practitioners' awareness of depression and anxiety with change in quality of life in heart failure patients: results of the prospective observational RECODE-HF cohort study. Fam Pract 2022; 39:346-353. [PMID: 34694380 DOI: 10.1093/fampra/cmab138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depression and anxiety are more prevalent in patients with heart failure (HF) than in the general population and reduce quality of life (QoL); therefore, clinical guidelines recommend screening HF patients for depression/anxiety. OBJECTIVE We investigated, whether the general practitioners' (GPs) awareness of patients' symptoms of depression and/or anxiety (psychosocial distress) was associated with a change in QoL. METHODS In this prospective observational study, we recruited 3,129 primary care HF patients in Germany. Patients completed baseline and 12-month follow-up questionnaires. Their GPs were interviewed. We identified 666 patients with psychosocial distress and compared 2 groups by analysis of covariance: 235 patients with psychosocial distress whose GP was aware of the psychosocial distress and 431 patients with psychosocial distress whose GP was unaware of such distress. Primary outcome was the change in QoL, assessed by the EQ-5D visual analogue scale. RESULTS Patients with psychosocial distress showed lower baseline QoL than those without (45.9 vs 64.1; P < 0.001). Within the patients with psychosocial distress, the GPs' awareness of psychosocial distress was not associated with improvement of QoL (F = 1.285; P = 0.258) or remission of psychosocial distress (odds ratio = 0.887; P = 0.608). CONCLUSION We found no association between the GPs' awareness of psychosocial distress and change in QoL. Although data for effective treatments of depression in HF are currently insufficient, psychosocial distress strongly impairs the QoL in HF patients. These findings might influence the development of clinical practice guidelines in HF.
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Affiliation(s)
- Marion Eisele
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rakebrandt
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrid Boczor
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Blozik
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Luebeck, Germany
| | - Stefan Störk
- University and University Hospital Würzburg, Comprehensive Heart Failure Center Würzburg, Würzburg, Germany
| | - Christoph Herrmann-Lingen
- University of Göttingen Medical Center, and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kakutani N, Yokota T, Fukushima A, Obata Y, Ono T, Sota T, Kinugasa Y, Takahashi M, Matsuo H, Matsukawa R, Yoshida I, Kakinoki S, Yonezawa K, Himura Y, Yokota I, Yamamoto K, Tsuchihashi-Makaya M, Kinugawa S. Impact of citrus fruit intake on the mental health of patients with chronic heart failure. J Cardiol 2021; 79:719-726. [PMID: 34955372 DOI: 10.1016/j.jjcc.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/20/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The full impact of the intake of citrus fruits on the risk of depression in individuals with chronic heart failure (HF) is unknown. Here, we examined the associations between the estimated habitual intakes of citrus fruits and depressive symptoms in patients with chronic HF. METHODS We enrolled 150 stable outpatients with chronic HF who had a history of worsening HF. To assess the patients' daily dietary patterns, we used a brief self-administered diet-history questionnaire to calculate the daily consumption of foods and nutrients. To assess the patients' mental state, we used a nine-item Patient Health Questionnaire (PHQ-9). RESULTS Twelve patients (8%) were identified as having moderate-to-severe depression (PHQ-9 score ≥10). The patients with PHQ-9 ≥10 had lower daily intakes of citrus fruits compared to those with no or mild depressive symptoms (PHQ-9 <10). The daily intakes of various antioxidants, including vitamin C, β-carotene, and β-cryptoxanthin, all of which are abundant in citrus fruits, were reduced in the patients with PHQ-9 ≥10, accompanied by higher serum levels of 8-isoprostane (an oxidative stress marker). A multivariate logistic regression analysis using forward selection showed that a lowered daily intake of citrus fruits was an independent predictor of the comorbidity of moderate-to-severe depression in patients with chronic HF, after adjustment for age, gender, and the hemoglobin value. CONCLUSIONS A lower daily consumption of citrus fruits was associated with higher prevalence of depression in patients with chronic HF. Our findings support the hypothesis that a daily consumption of citrus fruits has a beneficial effect on the prevention and treatment of depression in chronic HF patients.
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Affiliation(s)
- Naoya Kakutani
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Yokota
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Kita-14 Nishi-5, Kita-Ku, Sapporo 060-8648, Japan.
| | - Arata Fukushima
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshikuni Obata
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Taisuke Ono
- Department of Cardiology, Kitami Red Cross Hospital, Kitami, Japan
| | - Takeshi Sota
- Division of Rehabilitation, Tottori University Hospital, Tottori, Japan
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Tottori, Japan
| | | | - Hisashi Matsuo
- Department of Cardiology, Keiwakai Ebetsu Hospital, Ebetsu, Japan
| | - Ryuichi Matsukawa
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Ichiro Yoshida
- Department of Cardiology, Obihiro Kyokai Hospital, Obihiro, Japan
| | - Shigeo Kakinoki
- Department of Cardiology, Otaru Kyokai Hospital, Otaru, Japan
| | - Kazuya Yonezawa
- Department of Clinical Research, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Yoshihiro Himura
- Department of Cardiology, Hikone Municipal Hospital, Hikone, Japan
| | - Isao Yokota
- Department of Biostatistics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Tottori, Japan
| | | | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Oud FMM, Spies PE, Braam RL, van Munster BC. Recognition of cognitive impairment and depressive symptoms in older patients with heart failure. Neth Heart J 2020; 29:377-382. [PMID: 33320302 PMCID: PMC8271051 DOI: 10.1007/s12471-020-01527-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Cognitive impairment and depression in patients with heart failure (HF) are common comorbidities and are associated with increased morbidity, readmissions and mortality. Timely recognition of cognitive impairment and depression is important for providing optimal care. The aim of our study was to determine if these disorders were recognised by clinicians and, secondly, if they were associated with hospital admissions and mortality within 6 months' follow-up. METHODS Patients (aged ≥65 years) diagnosed with HF were included from the cardiology outpatient clinic of Gelre Hospitals. Cognitive status was evaluated with the Montreal Cognitive Assessment test (score ≤22). Depressive symptoms were assessed with the Geriatric Depression Scale (score >5). Patient characteristics were collected from electronic patient files. The clinician was blinded to the tests and asked to assess cognitive status and mood. RESULTS We included 157 patients. Their median age was 79 years (65-92); 98 (62%) were male. The majority had New York Heart Association functional class II. Cognitive impairment was present in 56 (36%) patients. Depressive symptoms were present in 21 (13%) patients. In 27 of 56 patients (48%) cognitive impairment was not recognised by clinicians. Depressive symptoms were not recognised in 11 of 21 patients (52%). During 6 months' follow-up 24 (15%) patients were readmitted for HF-related reasons and 18 (11%) patients died. There was no difference in readmission and mortality rate between patients with or without cognitive impairment and patients with or without depressive symptoms. CONCLUSION Cognitive impairment and depressive symptoms were infrequently recognised during outpatient clinic visits.
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Affiliation(s)
- F M M Oud
- Department of Geriatrics, Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands. .,Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands.
| | - P E Spies
- Department of Geriatrics, Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands
| | - R L Braam
- Department of Cardiology, Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands
| | - B C van Munster
- Department of Geriatrics, Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands.,Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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10
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Vargas EA, Patel RB, Medina-Lezama J, Chirinos DA. Depressive Symptoms Are Associated with Reduced Cardiac Function Among Hispanics: Results from the PREVENCION Study. Int J Behav Med 2020; 28:531-539. [PMID: 33170471 DOI: 10.1007/s12529-020-09941-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Depressive symptoms are common among patients with heart failure and are often associated with adverse outcomes, including re-hospitalization and mortality. However, little is known about the association between depressive symptoms and subclinical markers of heart failure and cardiac function in community-based samples and little research has focused on South American Hispanics. The current study examined the cross-sectional association between depressive symptoms and cardiac function in South American Hispanic community-based adults. METHODS Participants included 527 adults enrolled in the Peruvian Study of Cardiovascular Disease (PREVENCION). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS). Markers of cardiac function were assessed by impedance cardiography and included cardiac output, cardiac index, stroke volume, and stroke volume index. Several multiple regression analyses were used to examine the association between depressive symptoms and markers of cardiac function. RESULTS In adjusted analyses, depressive symptoms were associated with reduced cardiac output, cardiac index, stroke volume, and stroke volume index. These associations remained significant between depressive symptoms and cardiac output (β = - 0.106, p = 0.014), cardiac index (β = - 0.099, p = 0.029), and stroke volume (β = - 0.095, p = 0.022), and a trend was still observed between depressive symptoms and stroke index (β = - 0.083, p = 0.061), even after having controlled for demographic factors (age, gender, education), cardiovascular risk factors (smoking status, body mass index, low- and high-density lipoprotein cholesterol, triglycerides, fasting glucose, serum creatinine), and comorbidities (diabetes mellitus, hypertension, hypercholesterolemia). CONCLUSIONS In the PREVENCION sample tested, depressive symptoms were independently associated with cardiac function among Hispanic adults, even above and beyond pertinent factors such as demographic factors, cardiovascular risk factors, and comorbidities. Future studies should determine whether depressive symptoms are prospectively associated with systolic dysfunction, and examine the bio-behavioral pathways of this association.
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Affiliation(s)
- Emily A Vargas
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 Lake Shore Dr, Chicago, IL, 60611, USA.
| | - Ravi B Patel
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 Lake Shore Dr, Chicago, IL, 60611, USA
| | | | - Diana A Chirinos
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 Lake Shore Dr, Chicago, IL, 60611, USA
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11
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Lin XX, Gao BB, Huang JY. Prevalence of depressive symptoms in patients with Heart Failure in China: a meta-analysis of comparative studies and epidemiological surveys. J Affect Disord 2020; 274:774-783. [PMID: 32664014 DOI: 10.1016/j.jad.2020.05.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/05/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although depressive symptoms is a frequent psychiatric comorbidity in people with Heart Failure (HF) in China, its prevalence was not estimated. This is a meta-analysis of studies examining depressive symptoms in HF patients in China. METHODS The following databases including PubMed, the Cochrace Library, Embase, China National Knowledge Infrastructure (CNKI), WanFang and VIP were independently and systematically searched from inception until March 31, 2019. Statistical analyses were performed using the Stata 13.0 software. The pooled prevalence of depressive symptoms was performed using a random-effects model. In addition, subgroup analysis was conducted based on the New York Heart Association (NYHA) functional class, the assessment tools of depression and gender. RESULTS Altogether 53 studies (10649 participants) met the inclusion criteria for the analysis. The point prevalence of depressive symptoms in HF was 43%. In subgroup analyses, the prevalence of depressive symptoms was higher in females than in males (46% vs 34%, respectively), and the prevalence of depressive symptoms positively correlated with New York Heart Association functional classes (II 28%, III 46%, IV 52%) . Rates of depression were highest when measured using BDI scale (62%), and lowest when measured using the CES-D (31%). CONCLUSIONS This meta-analysis confirmed that the prevalence of depressive symptoms was common in HF patients in China and it is related to the severity of heart failure, gender and the diversity of assessment tools. Appropriate strategies for prevention and treatment of depressive symptoms in this population need greater attention.
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Affiliation(s)
- Xiao-Xiao Lin
- Department of cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Bei-Bei Gao
- Department of cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Jin-Yu Huang
- Department of cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine.
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12
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Conley MI, Hindley I, Baskin-Sommers A, Gee DG, Casey BJ, Rosenberg MD. The importance of social factors in the association between physical activity and depression in children. Child Adolesc Psychiatry Ment Health 2020; 14:28. [PMID: 32607126 PMCID: PMC7321548 DOI: 10.1186/s13034-020-00335-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/16/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Physical activity is associated with reduced depression in youth and adults. However, our understanding of how different aspects of youth activities-specifically, the degree to which they are social, team-oriented, and physical-relate to mental health in children is less clear. METHODS Here we use a data-driven approach to characterize the degree to which physical and non-physical youth activities are social and team-oriented. We then examine the relationship between depressive symptoms and participation in different clusters of youth activities using mixed effect models and causal mediation analyses in 11,875 children from the Adolescent Brain Cognitive Development (ABCD) Study. We test our hypotheses in an original sample (n = 4520, NDA release 1.1) and replication sample of participants (n = 7355, NDA release 2.0.1). RESULTS We show and replicate that social-physical activities are associated with lower depressive symptoms. Next, we demonstrate that social connections, measured by number of close friends, partially mediate the association between social-physical activities and lower depressive symptoms. CONCLUSIONS Our results provide a rubric for using data-driven techniques to investigate different aspects of youth activities and highlight the social dynamics of physical activities as a possible protective factor against depression in childhood.
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Affiliation(s)
- May I. Conley
- Department of Psychology, Yale University, 2 Hillhouse Avenue, New Haven, CT 06520 USA
| | - Isabella Hindley
- Department of Psychology, Yale University, 2 Hillhouse Avenue, New Haven, CT 06520 USA
| | | | - Dylan G. Gee
- Department of Psychology, Yale University, 2 Hillhouse Avenue, New Haven, CT 06520 USA
| | - B. J. Casey
- Department of Psychology, Yale University, 2 Hillhouse Avenue, New Haven, CT 06520 USA
| | - Monica D. Rosenberg
- Department of Psychology, Yale University, 2 Hillhouse Avenue, New Haven, CT 06520 USA
- Department of Psychology, The University of Chicago, Chicago, IL USA
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13
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Figueroa JF, Phelan J, Orav EJ, Patel V, Jha AK. Association of Mental Health Disorders With Health Care Spending in the Medicare Population. JAMA Netw Open 2020; 3:e201210. [PMID: 32191329 PMCID: PMC7082719 DOI: 10.1001/jamanetworkopen.2020.1210] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The degree to which the presence of mental health disorders is associated with additional medical spending on non-mental health conditions is largely unknown. OBJECTIVE To determine the proportion and degree of total spending directly associated with mental health conditions vs spending on other non-mental health conditions. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of 4 358 975 fee-for-service Medicare beneficiaries in the US in 2015 compared spending and health care utilization among Medicare patients with serious mental illness (SMI; defined as bipolar disease, schizophrenia or related psychotic disorders, and major depressive disorder), patients with other common mental health disorders (defined as anxiety disorders, personality disorders, and posttraumatic stress disorder), and patients with no known mental health disorders. Data analysis was conducted from February to October 2019. EXPOSURE Diagnosis of an SMI or other common mental health disorder. MAIN OUTCOMES AND MEASURES Risk-adjusted, standardized spending and health care utilization. Multivariable linear regression models were used to adjust for patient characteristics, including demographic characteristics and other medical comorbidities, using hospital referral region fixed effects. RESULTS Of 4 358 975 Medicare beneficiaries, 987 379 (22.7%) had an SMI, 326 991 (7.5%) had another common mental health disorder, and 3 044 587 (69.8%) had no known mental illness. Compared with patients with no known mental illness, patients with an SMI were younger (mean [SD] age, 72.3 [11.6] years vs 67.4 [15.7] years; P < .001) and more likely to have dual eligibility (633 274 [20.8%] vs 434 447 [44.0%]; P < .001). Patients with an SMI incurred more mean (SE) spending on mental health services than those with other common mental health disorders or no known mental illness ($2024 [3.9] vs $343 [6.2] vs $189 [2.1], respectively; P < .001). Patients with an SMI also had substantially higher mean (SE) spending on medical services for physical conditions than those with other common mental health disorders or no known mental illness ($17 651 [23.6] vs $15 253 [38.2] vs $12 883 [12.8], respectively; P < .001), reflecting $4768 (95% CI, $4713-$4823; 37% increase) more in costs for patients with an SMI and $2370 (95% CI, $2290-$2449; 18.4% increase) more in costs for patients with other common mental health disorders. Among Medicare beneficiaries, $2 686 016 110 of $64 326 262 104 total Medicare spending (4.2%) went to mental health services and an additional $5 482 791 747 (8.5%) went to additional medical spending associated with mental illness, representing a total of 12.7% of spending associated with mental health disorders. CONCLUSIONS AND RELEVANCE In this study, having a mental health disorder was associated with spending substantially more on other medical conditions. These findings quantify the extent of additional spending in the Medicare fee-for-service population associated with a diagnosis of a mental health disorder.
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Affiliation(s)
- Jose F. Figueroa
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jessica Phelan
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - E. John Orav
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ashish K. Jha
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Harvard Global Health Institute, Harvard University, Cambridge, Massachusetts
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14
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Wadhera RK, Khatana SAM, Choi E, Jiang G, Shen C, Yeh RW, Joynt Maddox KE. Disparities in Care and Mortality Among Homeless Adults Hospitalized for Cardiovascular Conditions. JAMA Intern Med 2020; 180:357-366. [PMID: 31738826 PMCID: PMC6865320 DOI: 10.1001/jamainternmed.2019.6010] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE Cardiovascular disease is a major cause of death among homeless adults, with mortality rates that are substantially higher than in the general population. It is unknown whether differences in hospitalization-related care contribute to these disparities in cardiovascular outcomes. OBJECTIVE To evaluate differences in intensity of care and mortality between homeless and nonhomeless individuals hospitalized for cardiovascular conditions (ie, acute myocardial infarction, stroke, cardiac arrest, or heart failure). DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study included all hospitalizations for cardiovascular conditions among homeless adults (n = 24 890) and nonhomeless adults (n = 1 827 900) 18 years or older in New York, Massachusetts, and Florida from January 1, 2010, to September 30, 2015. Statistical analysis was performed from February 6 to July 16, 2019. MAIN OUTCOMES AND MEASURES Risk-standardized diagnostic and therapeutic procedure rates and in-hospital mortality rates. RESULTS Of the 1 852 790 total hospitalizations for cardiovascular conditions across 525 hospitals, 24 890 occurred among patients who were homeless (11 452 women and 13 438 men; mean [SD] age, 65.1 [14.8] years) and 1 827 900 occurred among patients who were not homeless (850 660 women and 977 240 men; mean [SD] age, 72.1 [14.6] years). Most hospitalizations among homeless individuals were primarily concentrated among 11 hospitals. Homeless adults were more likely than nonhomeless adults to be black (38.6% vs 15.6%) and insured by Medicaid (49.3% vs 8.5%). After accounting for differences in demographics (age, sex, and race/ethnicity), insurance payer, and clinical comorbidities, homeless adults hospitalized for acute myocardial infarction were less likely to undergo coronary angiography compared with nonhomeless adults (39.5% vs 70.9%; P < .001), percutaneous coronary intervention (24.8% vs 47.4%; P < .001), and coronary artery bypass graft (2.5% vs 7.0%; P < .001). Among adults hospitalized with stroke, those who were homeless were less likely than nonhomeless individuals to undergo cerebral angiography (2.9% vs 9.5%; P < .001) but were as likely to receive thrombolytic therapy (4.8% vs 5.2%; P = .28). In the cardiac arrest cohort, homeless adults were less likely than nonhomeless adults to undergo coronary angiography (10.1% vs 17.6%; P < .001) and percutaneous coronary intervention (0.0% vs 4.7%; P < .001). Risk-standardized mortality was higher for homeless persons with ST-elevation myocardial infarction compared with nonhomeless persons (8.3% vs 6.2%; P = .04). Mortality rates were also higher for homeless persons than for nonhomeless persons hospitalized with stroke (8.9% vs 6.3%; P < .001) or cardiac arrest (76.1% vs 57.4%; P < .001) but did not differ for heart failure (1.6% vs 1.6%; P = .83). CONCLUSIONS AND RELEVANCE There are significant disparities in in-hospital care and mortality between homeless and nonhomeless adults with cardiovascular conditions. There is a need for public health and policy efforts to support hospitals that care for homeless persons to reduce disparities in hospital-based care and improve health outcomes for this population.
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Affiliation(s)
- Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sameed Ahmed M Khatana
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Eunhee Choi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ginger Jiang
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Karen E Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri.,Center for Health Economics and Policy, Institute for Public Health at Washington University, St Louis, Missouri
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15
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Lee H, Singh GK. Psychological Distress and Heart Disease Mortality in the United States: Results from the 1997-2014 NHIS-NDI Record Linkage Study. Int J MCH AIDS 2020; 9:260-273. [PMID: 32742741 PMCID: PMC7384336 DOI: 10.21106/ijma.391] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Despite the long-term decline, heart disease has remained the leading cause of death in the United States (US) over the past eight decades, accounting for 23% of all deaths in 2017. Although psychological distress has been associated with cardiovascular disease mortality, the relationship between different psychological distress levels and heart disease mortality in the US has not been analyzed in detail. Using a national longitudinal dataset, we examined the association between levels of psychological distress and US heart disease mortality. METHODS We analyzed the Kessler 6-item psychological distress scale as a risk factor for heart disease mortality using the pooled 1997-2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N=513,081). Cox proportional hazards regression was used to model survival time as a function of psychological distress and sociodemographic and behavioral covariates. RESULTS In Cox models with 18 years of mortality follow-up, the heart disease mortality risk was 121% higher (hazard ratio [HR]=2.21; 95% CI=1.99,2.45) in adults with serious psychological distress (SPD) (p<0.001), controlling for age, and 96% higher (HR=1.96; 95% CI=1.77,2.18) in adults with SPD (p<0.001), controlling for age, gender, race/ethnicity, immigrant status, education, marital status, poverty status, housing tenure, and geographic region when compared with adults without psychological distress. The relative risk of heart disease mortality associated with SPD decreased but remained significant (HR=1.14, 95% CI=1.02,1.28) after controlling for additional covariates of smoking, alcohol consumption, self-assessed health, activity limitation, and body mass index. There was a dose-response relationship, with relative risks of heart disease mortality increasing consistently at higher levels of psychological distress. Moreover, the association varied significantly by gender and race/ethnicity. The relative risk of heart disease mortality for those who experienced SPD was 2.42 for non-Hispanic Whites and 1.76 for non-Hispanic Blacks, compared with their counterparts who did not experience psychological distress. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS US adults with serious psychological distress had statistically significantly higher heart disease mortality risks than those without psychological distress. These findings underscore the significance of addressing psychological well-being in the population as a strategy for reducing heart disease mortality.
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Affiliation(s)
- Hyunjung Lee
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN 37831 USA
| | - Gopal K Singh
- US Department of Health and Human Services, Health Resources and Services Administration, Office of Health Equity, 5600 Fishers Lane, Rockville, MD 20857, USA
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16
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Das A, Roy B, Schwarzer G, Silverman MG, Ziegler O, Bandyopadhyay D, Philpotts LL, Sinha S, Blumenthal JA, Das S. Comparison of treatment options for depression in heart failure: A network meta-analysis. J Psychiatr Res 2019; 108:7-23. [PMID: 30419488 DOI: 10.1016/j.jpsychires.2018.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/18/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Depression independently predicts poor outcomes in heart failure (HF) patients, including increased mortality, morbidity and 30-day re-hospitalization. In this network meta-analysis, we compared different interventions designed to treat depression in HF. MATERIALS AND METHODS Electronic searches were conducted using Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and PsycINFO up to November 2016. Included randomized clinical trials (RCTs) compared interventions (Exercise therapy (ET), cognitive behavioral therapy (CBT) or antidepressant (AD) medications) for depression in heart failure patients. The primary outcome was change in depressive symptoms based on validated measures of depression. Network meta-analysis based on random effects model estimating standardized mean difference (SMD) with 95% confidence interval (CI), compared the effects of the 3 classes of interventions with respect to usual care or placebo control conditions. RESULTS A total of 21 RCTs (including 4563 HF patients) reporting the effects of treating depression in HF patients were included in the analysis. In comparison to placebo or usual standard of care, ET (SMD -0.38; 95% CI -0.54 to -0.22) and CBT (SMD -0.29; 95% CI -0.58 to -0.01) were associated with reduction in depressive symptoms whereas AD (SMD -0.16; 95% CI -0.44 to 0.11) was less effective. CONCLUSIONS This meta-analysis is suggestive of therapeutic benefit of ET and CBT in comparison to usual standard of care in treating depression in HF patients. However, comparison among the three interventions was not conclusive. Future randomized clinical trials are warranted to compare the therapeutic effects of ET, CBT and AD in such patients.
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Affiliation(s)
- Avash Das
- Division of Cardiology, Massachusetts General Hospital, Boston, USA.
| | - Bhaskar Roy
- Division of Neurology, Yale School of Medicine, Connecticut, USA
| | - Guido Schwarzer
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Germany
| | | | - Olivia Ziegler
- Division of Cardiology, Massachusetts General Hospital, Boston, USA
| | | | | | - Shirshendu Sinha
- Department of Psychiatry and Psychology, Mayo Clinic Health System and Mayo Clinic College of Medicine and Science, Mankato, MN, USA
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Saumya Das
- Division of Cardiology, Massachusetts General Hospital, Boston, USA
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17
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Zahid I, Baig MA, Ahmed Gilani J, Waseem N, Ather S, Farooq AS, Ghouri A, Siddiqui SN, Kumar R, Sahil, Suman, Kumar R, Kumar R, Mulla AA, Siddiqi R, Fatima K. Frequency and predictors of depression in congestive heart failure. Indian Heart J 2018; 70 Suppl 3:S199-S203. [PMID: 30595257 PMCID: PMC6309877 DOI: 10.1016/j.ihj.2018.10.410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/03/2018] [Accepted: 10/18/2018] [Indexed: 01/09/2023] Open
Abstract
Background Depression in congestive heart failure (CHF) patients can increase morbidity and mortality. Given the ever-rising prevalence of CHF patients with depression, it is vital that we understand the predictors of depression in these patients to identify and better manage these patients. The main objective of this study was to evaluate the frequency and predictors of depression in CHF patients. Methods A cross-sectional study was conducted in a tertiary care hospital. Patients with a diagnosis of CHF for more than 6 months based on signs and left ventricular ejection fraction <40% were included. Patients were interviewed with the Patient Health Questionnaire-9 (PHQ-9) consisting of nine items in line with the Diagnostic and Statistical Manual (DSM) - IV criteria to assess depression. Each item was scored from 0 to 3, and a PHQ-9 score of 10 or greater suggested clinical depression. Data were analyzed on SPSS, v22, and a p < 0.05 was considered significant. Results Of 170 participants, 102 (60%) had depression. Among these 102 patients, 42% (n = 43) had mild depression, and the rest (n = 59) had moderate-to-severe depression. Predictors of depression were New York Heart Association stage 3 or 4 (p = 0.001), previous myocardial infarction (p = 0.001), living without a partner (p = 0.001), lack of a joint family system (p = 0.001), sedentary lifestyle (p = 0.001), aged 70 years or more (p = 0.01), and having been admitted in a hospital at least once in the past two months (p = 0.002). Conclusion Depression is common among patients with CHF. It is associated with multiple factors and needs to be addressed and targeted urgently.
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Affiliation(s)
| | | | | | | | | | | | - Amna Ghouri
- Dow University of Health Sciences, Pakistan.
| | | | - Ram Kumar
- Chandka Medical College, Larkana, Pakistan.
| | - Sahil
- Chandka Medical College, Larkana, Pakistan.
| | - Suman
- Chandka Medical College, Larkana, Pakistan.
| | - Raj Kumar
- Chandka Medical College, Larkana, Pakistan.
| | - Ravi Kumar
- Chandka Medical College, Larkana, Pakistan.
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18
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Underner M, Cuvelier A, Peiffer G, Perriot J, Jaafari N. Influence de l’anxiété et de la dépression sur les exacerbations au cours de la BPCO. Rev Mal Respir 2018; 35:604-625. [PMID: 29937312 DOI: 10.1016/j.rmr.2018.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/13/2018] [Indexed: 02/05/2023]
Affiliation(s)
- M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur CS 10587, 86021 Poitiers cedex, France.
| | - A Cuvelier
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, centre hospitalier universitaire de Rouen, 76031 Rouen, France; Université de Rouen-Normandie, UPRES EA3830 groupe de recherche sur le handicap ventilatoire (GRHV), Institut de recherche et d'innovation biomédicale (IRIB), 76000 Rouen, France
| | - G Peiffer
- Service de pneumologie, centre hospitalier régional Metz-Thionville, 57038 Metz, France
| | - J Perriot
- Dispensaire Émile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur CS 10587, 86021 Poitiers cedex, France
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19
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Association of depression with evolution of heart failure in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2018; 17:19. [PMID: 29368650 PMCID: PMC5781289 DOI: 10.1186/s12933-018-0664-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/16/2018] [Indexed: 02/07/2023] Open
Abstract
Background Depression is a prevalent, independent predictor of mortality in patients with heart failure (HF). Depression is also common in type 2 diabetes mellitus (T2DM), which is itself an important risk factor for HF. However, association of depression with incident HF in T2DM is undefined. The aim of the present study was to evaluate the predictive value of depression in predicting incident HF in a community-based cohort of asymptomatic patients with T2DM. Methods We prospectively recruited 274 asymptomatic T2DM patients ≥ 65 years (age 71 ± 4 year, 56% men) with preserved EF and no ischemic heart disease from a community-based population. The Patient Health Questionnaire 9 (PHQ-9) was used to detect depression, and LV dysfunction was sought with a comprehensive echocardiogram, including LV hypertrophy (LVH) and subclinical diastolic function (E/e′). Over a median follow-up of 1.5 years (range 0.5–3), 20 patients were lost to follow-up and 254 individuals were followed for outcomes. Results At baseline, depression was present in 9.5%, LVH was identified in 26% and reduced E/e′ in 11%. Over a median follow-up of 1.5 years, 37 of 245 patients developed new-onset HF and 3 died, giving an event rate of 107/1000 person-years. In a competing-risks regression analysis, depression (adjusted HR 2.54, 95% CI 1.18–5.46; p = 0.017) was associated with incident HF and had incremental predictive power to clinical, biochemical and echocardiographic variables. Conclusion Depression is prevalent in asymptomatic elderly patients with T2DM, and depression independently and incrementally predicts incident HF.
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Borkenhagen LS, McCoy RG, Havyer RD, Peterson SM, Naessens JM, Takahashi PY. Symptoms Reported by Frail Elderly Adults Independently Predict 30-Day Hospital Readmission or Emergency Department Care. J Am Geriatr Soc 2017; 66:321-326. [PMID: 29231962 DOI: 10.1111/jgs.15221] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the degree to which self-reported symptoms predict unplanned readmission or emergency department (ED) care within 30 days of high-risk, elderly adults enrolled in a posthospitalization care transition program (CTP). DESIGN Retrospective cohort study. SETTING Posthospitalization CTP at Mayo Clinic, Rochester, Minnesota, from January 1, 2013, through March 3, 2015. PARTICIPANTS Frail, elderly adults (N = 230; mean age 83.5 ± 8.3, 46.5% male). MEASUREMENTS Charlson Comorbidity Index (CCI) and self-reported symptoms, measured using the Edmonton Symptom Assessment System (ESAS), were ascertained upon CTP enrollment. RESULTS Mean CCI was 3.9 ± 2.3. Of 51 participants returning to the hospital within 30 days of discharge, 13 had ED visits, and 38 were readmitted. Age, sex, and CCI were not significantly different between returning and nonreturning participants, but returning participants were significantly more likely to report shortness of breath (P = .004), anxiety (P = .02), depression (P = .02), and drowsiness (P = .01). Overall ESAS score was also a significant predictor of hospital return (P = .01). CONCLUSION Four self-reported symptoms and overall ESAS score, but not CCI, ascertained after hospital discharge were strong predictors of hospital return within 30 days. Including symptoms in risk stratification of high-risk elderly adults may help target interventions and reduce readmissions.
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Affiliation(s)
- Lynn S Borkenhagen
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rozalina G McCoy
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota
| | - Rachel D Havyer
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephanie M Peterson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - James M Naessens
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Eisele M, Boczor S, Rakebrandt A, Blozik E, Träder JM, Störk S, Herrmann-Lingen C, Scherer M. General practitioners' awareness of depressive symptomatology is not associated with quality of life in heart failure patients - cross-sectional results of the observational RECODE-HF Study. BMC FAMILY PRACTICE 2017; 18:100. [PMID: 29221442 PMCID: PMC5723041 DOI: 10.1186/s12875-017-0670-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Depression is a common comorbidity in patients with chronic heart failure (HF) and linked to a wider range of symptoms which, in turn, are linked to a decreased health-related quality of life (HRQOL). Treatment of depression might improve HRQOL but detecting depression is difficult due to the symptom overlap between HF and depression. Therefore, clinical guidelines recommend to routinely screen for depression in HF patients. No studies have so far investigated the treatment after getting aware of a depressive symptomatology and its correlation with HRQOL in primary care HF patients. Therefore, we examined the factors linked to depression treatment and those linked to HRQOL in HF patients. We hypothesized that GPs' awareness of depressive symptomatology was associated with depression treatment and HRQOL in HF patients. METHODS For this observational study, HF patients were recruited in primary care practices and filled out a questionnaire including PHQ-9 and HADS. A total of 574 patients screened positive for depressive symptomatology. Their GPs were interviewed by phone regarding the patients' comorbidities and potential depression treatment. Descriptive and regression analysis were performed. RESULTS GPs reported various types of depression treatments (including dialogue/counselling by the GP him/herself in 31.8% of the patients). The reported rates differed considerably between GP-reported initiated treatment and patient-reported utilised treatment regarding psychotherapy (16.4% vs. 9.5%) and pharmacotherapy (61.2% vs. 30.3%). The GPs' awareness of depressive symptomatology was significantly associated with the likelihood of receiving pharmacotherapy (OR 2.8; p < 0.001) but not psychotherapy. The patient's HRQOL was not significantly associated with the GPs' awareness of depression. CONCLUSION GPs should be aware of the gap between GP-initiated and patient-utilised depression treatments in patients with chronic HF, which might lead to an undersupply of depression treatment. It remains to be investigated why GPs' awareness of depressive symptomatology is not linked to patients' HRQOL. We hypothesize that GPs are aware of cases with reduced HRQOL (which improves under depression treatment) and unaware of cases whose depression do not significantly impair HRQOL, resulting in comparable levels of HRQOL in both groups. This hypothesis needs to be further investigated.
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Affiliation(s)
- Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Sigrid Boczor
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Anja Rakebrandt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Eva Blozik
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 2a, 97078 Würzburg, Germany
| | - Christoph Herrmann-Lingen
- University of Göttingen Medical Center, and German Center for Cardiovascular Research, partner site Göttingen, von-Siebold-Str. 5, D-37099 Göttingen, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Corbineau S, Breton M, Mialet-Perez J, Costemale-Lacoste JF. Major depression and heart failure: Interest of monoamine oxidase inhibitors. Int J Cardiol 2017; 247:1-6. [DOI: 10.1016/j.ijcard.2017.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 06/25/2017] [Accepted: 07/04/2017] [Indexed: 12/25/2022]
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Gathright EC, Dolansky MA, Gunstad J, Redle JD, Josephson R, Moore SM, Hughes JW. The impact of medication nonadherence on the relationship between mortality risk and depression in heart failure. Health Psychol 2017; 36:839-847. [PMID: 28726471 PMCID: PMC5573609 DOI: 10.1037/hea0000529] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Heart failure affects more than 5 million U.S. adults, and approximately 20% of individuals with heart failure experience depressive symptoms. Depression is detrimental to prognosis in heart failure, conferring approximately a 2-fold increase in mortality risk. Medication nonadherence may help explain this relationship because depressed patients are less likely to adhere to the medication regimen. METHOD Depression, electronically monitored medication adherence, and mortality were measured in a sample of 308 patients with heart failure participating in a study of self-management behavior. Cardiovascular and all-cause mortality data were obtained from the Centers for Disease Control and Prevention's National Death Index (median 2.9-year follow-up). Cox proportional hazards regression was used to assess the relationship between depression and mortality, with and without adjustment for age, gender, disease severity, and medication nonadherence. RESULTS In adjusted analyses, depression was associated with an increased all-cause mortality risk (hazard ratio 1.87; 95% confidence interval 1.04-3.37). Depression was not related to cardiovascular mortality, potentially because of a low number of cardiac-related deaths. When medication nonadherence was added to the model, nonadherence (hazard ratio 1.01; 95% confidence interval 1.004-1.02), but not depression, predicted all-cause mortality risk. CONCLUSIONS Depressive symptoms confer increased all-cause mortality risk in heart failure, and medication nonadherence contributes to this relationship. Depression and nonadherence represent potentially modifiable risk factors for poor prognosis. Future research is needed to understand whether interventions that concomitantly target these factors can improve outcomes. (PsycINFO Database Record
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Affiliation(s)
| | - Mary A. Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Joseph D. Redle
- Cardiovascular Institute, Summa Health System, Akron City Hospital, Akron, OH
| | - Richard Josephson
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH
| | - Shirley M. Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - Joel W. Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH
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Podolecki T, Pudlo R, Mazurek M, Koziel M, Jedrzejczyk-Patej E, Boidol J, Przybylska K, Sokal A, Kowalski O, Kowalczyk J, Lenarczyk R, Kalarus Z. The Incidence, Clinical Significance, and Treatment Effects of Depression in Cardiac Resynchronization Therapy Recipients. Cardiology 2017. [DOI: 10.1159/000475522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives: Chronic heart failure (HF) is associated with significantly increased prevalence of depression. The aim of the study was to assess the incidence and clinical impact of depression as well as the effectiveness of depression treatment in HF patients. Methods: A prospective interventional trial included 285 consecutive cardiac resynchronization therapy recipients. Patients underwent a psychiatric examination at the time of implantation and then it was routinely repeated at 3, 6, and 12 months after the procedure, and every 6 months thereafter. One hundred and thirty-five (47.4%) patients with depression were included in the depression group, whereas the control group was comprised of 150 patients free of depression. Sixty-eight (50.4%) subjects received antidepressants (treated group), whereas the observational group had 67 (49.6%) depressed patients who refused to take antidepressants. Results: Depression remission was achieved in 51 (75.0%) patients from the treated group. Long-term mortality and HF hospitalization rates were significantly higher in the depression group than in the control group (20.7 vs. 11.3% and 32.6 vs. 19.2%, respectively). However, remission from depression was associated with a 40% reduction in the relative risk of major adverse cardiac events (MACE). Conclusions: Patients with HF and concomitant depression are at higher risk of MACE compared with those free of depression. Effective antidepressant treatment may significantly improve long-term outcomes in this population.
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Carnevali L, Montano N, Statello R, Sgoifo A. Rodent models of depression-cardiovascular comorbidity: Bridging the known to the new. Neurosci Biobehav Rev 2017; 76:144-153. [DOI: 10.1016/j.neubiorev.2016.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/27/2016] [Accepted: 11/09/2016] [Indexed: 12/22/2022]
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Trebatická J, Dukát A, Ďuračková Z, Muchová J. Cardiovascular diseases, depression disorders and potential effects of omega-3 fatty acids. Physiol Res 2017; 66:363-382. [PMID: 28248536 DOI: 10.33549/physiolres.933430] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) and depressive disorders (DD) are two of the most prevalent health problems in the world. Although CVD and depression have different origin, they share some common pathophysiological characteristics and risk factors, such as the increased production of proinflammatory cytokines, endothelial dysfunction, blood flow abnormalities, decreased glucose metabolism, elevated plasma homocysteine levels, oxidative stress and disorder in vitamin D metabolism. Current findings confirm the common underlying factors for both pathologies, which are related to dramatic dietary changes in the mid-19th century. By changing dietary ratio of omega-6 to omega-3 fatty acids from 1:1 to 15-20:1 some changes in metabolism were induced, such as increased pro-inflammatory mediators and modulations of different signaling pathways following pathophysiological response related to both, cardiovascular diseases and depressive disorders.
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Affiliation(s)
- J Trebatická
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Comenius University and Child University Hospital, Bratislava, Slovakia; Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
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Goldstein CM, Gathright EC, Garcia S. Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team. Patient Prefer Adherence 2017; 11:547-559. [PMID: 28352161 PMCID: PMC5359120 DOI: 10.2147/ppa.s127277] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Many individuals with cardiovascular disease (CVD) experience depression that is associated with poor health outcomes, which may be because of medication nonadherence. Several factors influence medication adherence and likely influence the relationship between depression and medication adherence in CVD patients. This comprehensive study reviews the existing literature on depression and medication adherence in CVD patients, addresses the methods of and problems with measuring medication adherence, and explains why the integrated care team is uniquely situated to improve the outcomes in depressed CVD patients. This paper also explores how the team can collaboratively target depressive symptoms and medication-taking behavior in routine clinical care. Finally, it suggests the limitations to the integrated care approach, identifies targets for future research, and discusses the implications for CVD patients and their families.
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Affiliation(s)
- Carly M Goldstein
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI
- Correspondence: Carly M Goldstein, Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University, The Miriam Hospital, 196 Richmond Street, Providence, RI 02903, USA, Tel +1 401 793 8960, Fax +1 401 793 8944, Email
| | - Emily C Gathright
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Sarah Garcia
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Kulej-Lyko K, Majda J, von Haehling S, Doehner W, Lopuszanska M, Szklarska A, Banasiak W, Anker SD, Ponikowski P, Jankowska EA. Could gonadal and adrenal androgen deficiencies contribute to the depressive symptoms in men with systolic heart failure? Aging Male 2016; 19:221-230. [PMID: 27650467 DOI: 10.1080/13685538.2016.1208166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Testosterone (TT) and dehydroepiandrosterone sulphate (DHEAS) are neurosteroids and their deficiencies constitute the hormone risk factors promoting the development of depression in elderly otherwise healthy men. We investigated the link between hypogonadism and depression in accordance with age and concomitant diseases in men with systolic HF using the novel scale previously dedicated for elderly population. METHODS We analysed the prevalence of depression and severity of depressive symptoms in population of 226 men with systolic HF (40-80 years) compared to 379 healthy peers. The severity of depression was assessed using the Polish long version of Geriatric Depression Scale (GDS). RESULTS In men aged 40-59 years the severity of depressive symptoms was greater in NYHA classes III-IV compared to NYHA classes I-II and reference group. In men aged 60-80 years depressive symptoms were more severe in NYHA class III-IV compared to controls (all p ≤ 0.001). In multivariate logistic regression model in men aged 40-59 years advanced NYHA class was associated with higher prevalence of mild depression (OR = 2.14, 95%CI: 1.07-4.29) and chronic obstructive pulmonary disease (COPD) with higher prevalence of severe depression (OR = 69.1, 95%CI: 2.11-2264.3). In men aged 60-80 years advanced NYHA class and TT deficiency were related to higher prevalence of mild depression (respectively: OR = 2.9, 95%CI: 1.3-6.4; OR = 3.6, 95%CI: 1.2-10.63). CONCLUSION TT deficiency, COPD and advanced NYHA class were associated with higher prevalence of depression in men with systolic HF.
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Affiliation(s)
| | - Jacek Majda
- b Laboratory Department , Military Hospital , Wroclaw , Poland
| | - Stephan von Haehling
- c Applied Cachexia Research, Department of Cardiology, Charité Medical School , Berlin , Germany
| | - Wolfram Doehner
- c Applied Cachexia Research, Department of Cardiology, Charité Medical School , Berlin , Germany
- d Center for Stroke Research Berlin, Charité Medical School , Berlin , Germany
| | - Monika Lopuszanska
- e Polish Academy of Sciences, Institute of Anthropology , Wroclaw , Poland
| | - Alicja Szklarska
- e Polish Academy of Sciences, Institute of Anthropology , Wroclaw , Poland
| | | | - Stefan D Anker
- c Applied Cachexia Research, Department of Cardiology, Charité Medical School , Berlin , Germany
- f Centre for Clinical and Basic Research, IRCCS San Raffaele , Rome , Italy , and
| | - Piotr Ponikowski
- a Centre for Heart Diseases, Military Hospital , Wroclaw , Poland
- g Laboratory for Applied Research on Cardiovascular System , Department of Heart Diseases, Wroclaw Medical University , Wroclaw , Poland
| | - Ewa A Jankowska
- a Centre for Heart Diseases, Military Hospital , Wroclaw , Poland
- e Polish Academy of Sciences, Institute of Anthropology , Wroclaw , Poland
- g Laboratory for Applied Research on Cardiovascular System , Department of Heart Diseases, Wroclaw Medical University , Wroclaw , Poland
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Moser DK, Arslanian-Engoren C, Biddle MJ, Chung ML, Dekker RL, Hammash MH, Mudd-Martin G, Alhurani AS, Lennie TA. Psychological Aspects of Heart Failure. Curr Cardiol Rep 2016; 18:119. [DOI: 10.1007/s11886-016-0799-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Adelborg K, Schmidt M, Sundbøll J, Pedersen L, Videbech P, Bøtker HE, Egstrup K, Sørensen HT. Mortality Risk Among Heart Failure Patients With Depression: A Nationwide Population-Based Cohort Study. J Am Heart Assoc 2016; 5:JAHA.116.004137. [PMID: 27604456 PMCID: PMC5079053 DOI: 10.1161/jaha.116.004137] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background The prevalence of depression is 4‐ to 5‐fold higher in heart failure patients than in the general population. We examined the influence of depression on all‐cause mortality in patients with heart failure. Methods and Results Using Danish medical registries, this nationwide population‐based cohort study included all patients with a first‐time hospitalization for heart failure (1995–2014). All‐cause mortality risks and 19‐year mortality rate ratios were estimated based on Cox regression analysis, adjusting for age, sex, time period, comorbidity, and socioeconomic status. The analysis included 9636 patients with and 194 887 patients without a diagnosis of depression. Compared with patients without a history of depression, those with depression had higher 1‐year (36% versus 33%) and 5‐year (68% versus 63%) mortality risks. Overall, the adjusted mortality rate ratio was 1.03 (95% CI 1.01–1.06). Compared with no depression, the adjusted mortality rate ratios for mild, moderate, and severe depression, as defined by diagnostic codes, were 1.06 (95% CI 1.00–1.13), 1.03 (95% CI 0.99–1.08), and 1.02 (95% CI 0.96–1.09), respectively. In a subcohort of patients, the mortality rate ratios were modified by left ventricular ejection fraction, with adjusted mortality rate ratios of 1.17 (95% CI, 1.05–1.31) for ≤35%, 0.98 (95% CI 0.81–1.18) for 36% to 49%, and 0.96 (95% CI 0.74–1.25) for ≥50%. Results were consistent after adjustment for alcohol abuse and smoking. Conclusions A history of depression was an adverse prognostic factor for all‐cause mortality in heart failure patients with left ventricular ejection fraction ≤35% but not for other heart failure patients.
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Affiliation(s)
- Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark Department of Medical Research, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark
| | - Jens Sundbøll
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Kenneth Egstrup
- Department of Medical Research, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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Ramos S, Prata J, Bettencourt P, Gonçalves FR, Coelho R. Depression predicts mortality and hospitalization in heart failure: A six-years follow-up study. J Affect Disord 2016; 201:162-70. [PMID: 27235819 DOI: 10.1016/j.jad.2016.05.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 05/17/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the prevalence of depressive symptoms (DS) and its relation on hospitalization for cardiovascular (CV) causes and all-cause mortality risk among outpatients with HF. METHODS A prospective study was conducted on 130 adult outpatients with HF. The Beck Depression Inventory Scale-second edition (BDI-II) was used to screen for DS. All-cause mortality and hospitalization for CV causes were registered over 6 years. Logistic regression and multinomial logistic regression analysis were used to evaluate the independent prognostic value of DS on mortality and hospitalization for CV causes after adjustment for clinical risk factors. RESULTS During a mean follow-up of 6 years, 44% of patients were classified as having DS. Sixty-two participants died for all causes, representing 61% of those with DS and 37% of those without (p=0.006); Forty-nine participants (38%) were hospitalized for CV causes, representing 49% of those with DS and 29% of those without (p=0.027). Logistic regression analysis indicated that DS predicted all-cause mortality (OR: 2.905; 95% CI:1.228-6.870; p=0.006) and multinomial logistic regression indicated that DS were predictive of hospitalization for CV causes (OR: 3.169; 95% CI: 1.230-8.164; p=0.027). These associations were independent of conventional risk factors. LIMITATIONS Only outpatient sample; measure of DS only at baseline; cause of death was not known. CONCLUSION This study, first held in a portuguese population, showed that DS are independent predictors of death and hospitalization for CV causes among HF patients and its impact persists over 6 years.
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Affiliation(s)
- Sónia Ramos
- Cardiovascular Research Unit, Faculty of Medicine, University of Porto, Portugal.
| | - Joana Prata
- Cardiovascular Research Unit, Faculty of Medicine, University of Porto, Portugal
| | - Paulo Bettencourt
- Cardiovascular Research Unit, Faculty of Medicine, University of Porto, Portugal
| | | | - Rui Coelho
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal; Department of Clinical Neuroscience and Mental Health, Faculty of Medicine, University of Porto, Portugal
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The Impact of Body Mass Index on the Link Between Depressive Symptoms and Health Outcome in Patients With Heart Failure. J Cardiovasc Nurs 2016; 30:529-36. [PMID: 25325367 DOI: 10.1097/jcn.0000000000000196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depressive symptoms are predictors of shorter cardiac event-free survival, whereas increased body mass index (BMI) is associated with longer cardiac event-free survival in patients with heart failure (HF). However, the impact of BMI on the link between depressive symptoms and cardiac event-free survival is unexplored. The purpose of this study was to determine whether the relationship between depressive symptoms and cardiac event-free survival differs among HF patients stratified by BMI tertiles. METHODS A total of 297 outpatients with HF completed the Patient Health Questionnaire-9 to assess depressive symptoms. Body mass index was calculated as weight in kilograms divided by height in meters squared. Patients were followed for 1 year to determine cardiac event-free survival. Cox proportional hazard regression with survival curves was used to determine the relationships among depressive symptoms, BMI, and cardiac event-free survival. RESULTS Both depressive symptoms (P < .001) and lower BMI (P = .002) are independent predictors of shorter cardiac event-free survival after controlling for age, gender, etiology, total comorbidity scores, ejection fraction, New York Heart Association functional class, and prescribed medications. Patients with depressive symptoms had shorter cardiac event-free survival compared with patients without depressive symptoms in the lowest (P = .001) and middle (P = .036) BMI tertiles. There was no difference in cardiac event-free survival between patients with and without depressive symptoms in the highest tertile (P = .894). CONCLUSIONS Higher BMI has a protective role in the adverse effect of depressive symptoms on health outcomes in patients with HF.
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Depressive Symptoms among Patients with Heart Failure in Korea: An Integrative Review. Healthcare (Basel) 2016; 4:healthcare4030052. [PMID: 27527234 PMCID: PMC5041053 DOI: 10.3390/healthcare4030052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 11/17/2022] Open
Abstract
This integrative review was conducted to examine studies reporting depressive symptoms among patients with heart failure (HF) in Korea. An extensive search with both English and Korean search terms was conducted using six electronic databases. Publications were screened by both authors independently, and 10 articles meeting the inclusion criteria were reviewed. All 10 studies were data-based, quantitative, and descriptive in nature. In all studies, depressive symptoms were measured at only one point in time. The prevalence of depression reported in these studies ranged from 24% to 68%. Heterogeneity in the study samples and measures of depression was noted. Depressive symptoms have received limited attention in research with HF patients in Korea. Additional studies, especially longitudinal studies and intervention studies, are needed to assess depressive symptoms and to test the effects of pharmacological and non-pharmacological interventions on depression among patients with HF in Korea. Clinicians need to screen patients with HF for depressive symptoms using validated measures and provide proper treatment for those who are depressed.
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Jani BD, Mair FS, Roger VL, Weston SA, Jiang R, Chamberlain AM. Comorbid Depression and Heart Failure: A Community Cohort Study. PLoS One 2016; 11:e0158570. [PMID: 27362359 PMCID: PMC4928788 DOI: 10.1371/journal.pone.0158570] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 06/19/2016] [Indexed: 11/19/2022] Open
Abstract
Objective To examine the association between depression and clinical outcomes in heart failure (HF) in a community cohort. Patients and Methods HF patients in Minnesota, United States completed depression screening using the 9-item Patient Health Questionnaire (PHQ-9) between 1st Oct 2007 and 1st Dec 2011; patients with PHQ-9≥5 were labelled “depressed”. We calculated the risk of death and first hospitalization within 2 years using Cox regression. Results were adjusted for 10 commonly used prognostic factors (age, sex, systolic blood pressure, estimated glomerular filtration rate, serum sodium, ejection fraction, blood urea nitrogen, brain natriuretic peptide, presence of diabetes and ischaemic aetiology). Area under the curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) compared depression as a predictor against the aforementioned factors. Results 425 patients (mean age 74, 57.6% males) were included in the study; 179 (42.1%) had PHQ-9≥5. The adjusted hazard ratio of death was 2.02 (95% CI 1.34–3.04) and of hospitalization was 1.42 (95% CI 1.13–1.80) for those with compared to those without depression. Adding depression to the models did not appreciably change the AUC but led to statistically significant improvements in both the IDI (p = 0.001 and p = 0.005 for death and hospitalization, respectively) and NRI (for death and hospitalization, 35% (p = 0.002) and 27% (p = 0.007) were reclassified correctly, respectively). Conclusion Depression is frequent among community patients with HF and associated with increased risk of hospitalizations and death. Risk prediction for death and hospitalizations in HF patients can be improved by considering depression.
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Affiliation(s)
- Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Véronique L. Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Susan A. Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ruoxiang Jiang
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Alanna M. Chamberlain
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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Clinical and Prognostic Value of Depressive Symptoms and N-Terminal Pro-B-Type Natriuretic Peptide in Patients With Eisenmenger Syndrome. Psychosom Med 2015; 77:816-22. [PMID: 26355727 DOI: 10.1097/psy.0000000000000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Eisenmenger syndrome (ES) is commonly associated with depressive symptoms and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP). We investigated the predictive value of depressive symptoms and NTproBNP levels for long-term outcomes in patients with ES. METHODS Blood was drawn to measure NT-proBNP, and depressive symptoms were measured using the Korean version of the Beck Depression Inventory (BDI) in an outpatient clinic sample of 64 patients with ES (67% female; median age = 41.5 years [range, 21.0-74.8 years]). Cardiac events (hospitalization, emergency department visits, and cardiac death) were monitored during 3 years of follow-up. RESULTS During the follow-up period, 15 (23.4%) patients experienced a cardiac event. The combination of depressive symptoms and NT-proBNP levels better predicted future cardiac events than either variable alone. Patients with NT-proBNP > 510 pg/ml and a total BDI score > 10 had a 9.6 times higher risk for cardiac events than did patients with NT-proBNP ≤ 510 pg/ml or total BDI score ≤ 10 (p < .001). CONCLUSIONS Depressive symptoms and NT-proBNP levels are both associated with adverse clinical outcomes in ES.
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Diller GP, Bräutigam A, Kempny A, Uebing A, Alonso-Gonzalez R, Swan L, Babu-Narayan SV, Baumgartner H, Dimopoulos K, Gatzoulis MA. Depression requiring anti-depressant drug therapy in adult congenital heart disease: prevalence, risk factors, and prognostic value. Eur Heart J 2015; 37:771-82. [PMID: 26314687 DOI: 10.1093/eurheartj/ehv386] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/21/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression is prevalent in adults with congenital heart disease (ACHD), but limited data on the frequency of anti-depressant drug (ADD) therapy and its impact on outcome are available. METHODS AND RESULTS We identified all ACHD patients treated with ADDs between 2000 and 2011 at our centre. Of 6162 patients under follow-up, 204 (3.3%) patients were on ADD therapy. The majority of patients were treated with selective serotonin-reuptake inhibitors (67.4%), while only 17.0% of patients received tricyclic anti-depressants. Twice as many female patients used ADDs compared with males (4.4 vs. 2.2%, P < 0.0001). The percentage of patients on ADDs increased with disease complexity (P < 0.0001) and patient age (P < 0.0001). Over a median follow-up of 11.1 years, 507 (8.2%) patients died. After propensity score matching, ADD use was found to be significantly associated with worse outcome in male ACHD patients [hazard ratio 1.44 (95% confidence interval 1.17-1.84)]. There was no evidence that this excess mortality was directly related to ADD therapy, QT-prolongation, or malignant arrhythmias. However, males taking ADDs were also more likely to miss scheduled follow-up appointments compared with untreated counterparts, while no such difference in clinic attendance was seen in females. CONCLUSIONS The use of ADD therapy in ACHD relates to gender, age, and disease complexity. Although, twice as many female patients were on ADDs, it were their male counterparts, who were at increased mortality risk on therapy. Furthermore, males on ADDs had worse adherence to scheduled appointments suggesting the need for special medical attention and possibly psychosocial intervention for this group of patients.
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Affiliation(s)
- Gerhard-Paul Diller
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Str. 33, Muenster 48149, Germany
| | - Andrea Bräutigam
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Str. 33, Muenster 48149, Germany
| | - Aleksander Kempny
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
| | - Anselm Uebing
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
| | - Rafael Alonso-Gonzalez
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
| | - Lorna Swan
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
| | - Sonya V Babu-Narayan
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
| | - Helmut Baumgartner
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Str. 33, Muenster 48149, Germany
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
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Bender M, Smith TC. Using Administrative Mental Health Indicators in Heart Failure Outcomes Research: Comparison of Clinical Records and International Classification of Disease Coding. J Card Fail 2015; 22:56-60. [PMID: 26277906 DOI: 10.1016/j.cardfail.2015.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/24/2015] [Accepted: 08/04/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Use of mental indication in health outcomes research is of growing interest to researchers. This study, as part of a larger research program, quantified agreement between administrative International Classification of Disease (ICD-9) coding for, and "gold standard" clinician documentation of, mental health issues (MHIs) in hospitalized heart failure (HF) patients to determine the validity of mental health administrative data for use in HF outcomes research. METHODS A 13% random sample (n = 504) was selected from all unique patients (n = 3,769) hospitalized with a primary HF diagnosis at 4 San Diego County community hospitals during 2009-2012. MHI was defined as ICD-9 discharge diagnostic coding 290-319. Records were audited for clinician documentation of MHI. RESULTS A total of 43% (n = 216) had mental health clinician documentation; 33% (n = 164) had ICD-9 coding for MHI. ICD-9 code bundle 290-319 had 0.70 sensitivity, 0.97 specificity, and kappa 0.69 (95% confidence interval 0.61-0.79). More specific ICD-9 MHI code bundles had kappas ranging from 0.44 to 0.82 and sensitivities ranging from 42% to 82%. CONCLUSIONS Agreement between ICD-9 coding and clinician documentation for a broadly defined MHI is substantial, and can validly "rule in" MHI for hospitalized patients with heart failure. More specific MHI code bundles had fair to almost perfect agreement, with a wide range of sensitivities for identifying patients with an MHI.
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Affiliation(s)
- Miriam Bender
- Outcomes Research Institute, Sharp Healthcare, San Diego, California.
| | - Tyler C Smith
- Health and Life Science Analytics, Health Science Research Center, Department of Community Health, School of Health and Human Services, National University, San Diego, California
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Rasoul D, Potluri S, Wong SC, Gorantla RS, Aziz A, Chandran S, Uppal H, Potluri R. Psychiatric co-morbidities in patients with dilated cardiomyopathy. Int J Cardiol 2015; 191:71-3. [DOI: 10.1016/j.ijcard.2015.04.271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
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Okasha T, Radwan AS. The bidirectional relation between psychiatric disorders with selected cardiovascular and endocrinal diseases: an Egyptian perspective. Curr Psychiatry Rep 2015; 17:528. [PMID: 25413635 DOI: 10.1007/s11920-014-0528-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cardiovascular and endocrine diseases may act as burdens for individuals suffering from one of these medical illnesses, and whether through the ensuing psychological distress, or some biological mechanisms, these medical diseases can eventually lead to the development of psychiatric morbidities. Moreover, psychiatric morbidities negatively affect the prognosis of both cardiovascular and endocrine diseases. Despite transcultural differences, Egyptian patients with ischemic heart diseases (ISHD), heart failure (HF), diabetes mellitus (DM), or thyroid diseases (TD) endure the same psychological distress as their Western counterparts. Psychiatric assessment and evaluation should be regularly repeated among patients with cardiovascular and endocrinal diseases, and patients who are at risk should be closely followed up.
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Affiliation(s)
- Tarek Okasha
- Institute of Psychiatry, Ain Shams University, Cairo, Egypt,
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Reeves GC, Alhurani AS, Frazier SK, Watkins JF, Lennie TA, Moser DK. The association of comorbid diabetes mellitus and symptoms of depression with all-cause mortality and cardiac rehospitalization in patients with heart failure. BMJ Open Diabetes Res Care 2015; 3:e000077. [PMID: 26056566 PMCID: PMC4452727 DOI: 10.1136/bmjdrc-2014-000077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND More than 22% of individuals with diabetes mellitus have concomitant heart failure (HF), and the prevalence of diabetes in those with HF is nearly triple that of individuals without HF. Comorbid depressive symptoms are common in diabetes and HF. Depressive symptoms are an independent predictor of mortality in individuals with diabetes alone, as well as those with HF alone and are a predictor of rehospitalization in those with HF. However, the association of comorbid HF, diabetes and depressive symptoms with all-cause mortality and rehospitalization for cardiac causes has not been determined. OBJECTIVE The purpose of this study was to evaluate the association of comorbid HF, diabetes and depression with all-cause mortality and rehospitalization for cardiac cause. METHOD Patients provided data at baseline about demographic and clinical variables and depressive symptoms; patients were followed for at least 2 years. Participants were divided into four groups based on the presence and absence of diabetes and depressive symptoms. Cox regression analysis was used to determine whether comorbid diabetes and depressive symptoms independently predicted all-cause mortality and cardiac rehospitalization in these patients with HF. RESULTS Patients (n=663) were primarily male (69%), white (76%), and aged 61±13 years. All-cause mortality was independently predicted by the presence of concomitant diabetes and depressive symptoms (HR 3.71; 95% CI 1.49 to 9.25; p=0.005), and depressive symptoms alone (HR 2.29; 95% CI 0.94 to 5.40; p=0.05). The presence of comorbid diabetes and depressive symptoms was also an independent predictor of cardiac rehospitalization (HR 2.36; 95% CI 1.27 to 4.39; p=0.007). CONCLUSIONS Comorbid diabetes and depressive symptoms are associated with poorer survival and rehospitalization in patients with HF; effective strategies to regularly evaluate and effectively manage these comorbid conditions are necessary to improve survival and reduce rehospitalization rates.
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Affiliation(s)
| | - Abdullah S Alhurani
- University of Kentucky, Lexington, USA
- The University of Jordan, Amman, Jordan
| | | | | | | | - Debra K Moser
- University of Kentucky, Lexington, USA
- The University of Ulster, Newtownabbey, UK
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Choi NG, Kim J, Marti CN, Chen GJ. Late-life depression and cardiovascular disease burden: examination of reciprocal relationship. Am J Geriatr Psychiatry 2014; 22:1522-9. [PMID: 24856874 PMCID: PMC4351713 DOI: 10.1016/j.jagp.2014.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/10/2014] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Empirical studies of the relationship between depression and cardiovascular disease (CVD) tend to be limited to examination of one-way relationships. This study assessed both cross-sectional association and longitudinal reciprocal relationships between late-life depressive symptoms and CVD. METHODS The National Health and Aging Trends Study waves 1 (T1) and 2 (T2, one year later) provided the data. The study sample (N = 5,414) represented Medicare beneficiaries aged 65 years or older. We fit structural equation models to examine: 1) cross-sectional association between depression and CVD at each wave; and 2) longitudinal reciprocal relationship between T1 depression and T2 CVD and between T1 CVD and T2 depression. RESULTS At T1, 28.6% reported a CVD diagnosis, and at T2, 4.9% reported having had a new diagnosis or new episode of heart attack or heart disease and 2.2% reported having had a stroke since T1. In addition to significant cross-sectional relationships between depression and CVD, T1 CVD had significant impact on T2 depressive symptoms, and T1 depressive symptoms had significant impact on T2 CVD, with a 1-point increase in depressive symptom score increasing the odds of having a new CVD diagnosis or episode by 21%. CONCLUSIONS The care of older adults with CVD and/or depression needs to include interventions focusing on lifestyle and psychological factors that can reduce risks for both CVD and depression. Depression prevention and treatment also needs to be an integral part of CVD prevention and management.
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Affiliation(s)
- Namkee G Choi
- School of Social Work, University of Texas at Austin, Austin, TX.
| | - Jinseok Kim
- Department of Social Welfare, Seoul Women's University, Seoul, Korea
| | - C Nathan Marti
- Division of Statistics and Scientific Computation, College of Natural Sciences, University of Texas at Austin, Austin, TX
| | - G John Chen
- Division of Health Services Research, Department of Internal Medicine, the University of Kansas Medical Center, Kansas City, KS
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Joynt KE. So nice to see you again: physician continuity and outcomes for heart failure. JACC. HEART FAILURE 2014; 2:377-379. [PMID: 25023808 DOI: 10.1016/j.jchf.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/09/2014] [Indexed: 06/03/2023]
Affiliation(s)
- Karen E Joynt
- Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, and the VA Boston Healthcare System, Boston, Massachusetts.
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Parissis J, Karavidas A, Farmakis D, Papoutsidakis N, Matzaraki V, Arapi S, Potamitis N, Nikolaou M, Paraskevaidis I, Ikonomidis I, Pyrgakis V, Kremastinos D, Lekakis J, Filippatos G. Efficacy and safety of functional electrical stimulation of lower limb muscles in elderly patients with chronic heart failure: A pilot study. Eur J Prev Cardiol 2014; 22:831-6. [DOI: 10.1177/2047487314540546] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/02/2014] [Indexed: 11/15/2022]
Affiliation(s)
- John Parissis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | | | - Dimitrios Farmakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | | | | | - Sofia Arapi
- Department of Cardiology, G Gennimatas Hospital, Athens, Greece
| | | | - Maria Nikolaou
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Ioannis Paraskevaidis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Ignatios Ikonomidis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | | | - Dimitrios Kremastinos
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - John Lekakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
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Setoguchi M, Hashimoto Y, Sasaoka T, Ashikaga T, Isobe M. Risk factors for rehospitalization in heart failure with preserved ejection fraction compared with reduced ejection fraction. Heart Vessels 2014; 30:595-603. [PMID: 24935218 DOI: 10.1007/s00380-014-0532-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 05/30/2014] [Indexed: 02/08/2023]
Abstract
Although there have been several studies regarding heart failure with preserved ejection fraction (HFpEF), investigations of the risk factors for readmission of Japanese patients with HFpEF remain scarce. Therefore, our goal was to identify the risk factors for readmission of Japanese patients with heart failure (HF), particularly those with HFpEF. We analyzed 310 patients who were hospitalized for the first time with HF. Preserved EF was defined EF ≥50 %, and reduced EF (rEF) was EF <50 %. The study endpoint was readmission for HF after discharge. Medical history, vital signs, electrocardiograms, chest radiographs, blood tests and echocardiograms were compared between patients with HFpEF and with HFrEF. Among the 142 patients who had HFpEF, 43 reached the endpoint within 1 year. Multivariate analysis revealed depression (HR: 7.185), high brain natriuretic peptide (BNP) levels at discharge (HR: 1.003), and dilated inferior vena cava (HR: 1.100) as independent risk factors for readmission. In contrast, 39 of the 168 patients with HFrEF reached the endpoint. Risk factors for readmission of HFrEF patients were low sodium (HR: 0.856), high blood urea nitrogen (HR: 1.045), high BNP levels at discharge (HR: 1.003) and absence of beta-blocker prescription (HR: 0.395). In conclusion, our study suggests that the predictors of HF readmission differ between HFpEF and HFrEF patients.
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Affiliation(s)
- Masahiko Setoguchi
- Department of Cardiology, Kameda General Hospital, Kamogawa, Japan. .,Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Yuji Hashimoto
- Department of Cardiology, Kameda General Hospital, Kamogawa, Japan
| | - Taro Sasaoka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takashi Ashikaga
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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Teo R, Gollop ND, Baig M, Uppal H, Chandran S, Potluri R. The burden and trends of psychiatric co-morbidities amongst patients with cardiomyopathy. Int J Cardiol 2014; 174:398-9. [DOI: 10.1016/j.ijcard.2014.04.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
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Bhattacharya R, Shen C, Sambamoorthi U. Excess risk of chronic physical conditions associated with depression and anxiety. BMC Psychiatry 2014; 14:10. [PMID: 24433257 PMCID: PMC3902063 DOI: 10.1186/1471-244x-14-10] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 01/06/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Depression and anxiety have been reported to be associated with chronic physical conditions. We examined the excess risk of chronic physical conditions associated with depression and/or anxiety within a multivariate framework controlling for demographic and modifiable lifestyle risk factors. METHODS We used a retrospective cross-sectional study design. Study participants were adults aged 22-64 years from 2007 and 2009 Medical Expenditure Panel Survey. We defined presence of depression-anxiety based on self-reported depression and anxiety and classified adults into 4 groups: 1) depression only; 2) anxiety only; 3) comorbid depression and anxiety 4) no depression and no anxiety. We included presence/absence of arthritis, asthma, chronic obstructive pulmonary disorder, diabetes, heart disease, hypertension, and osteoporosis as dependent variables. Complementary log-log regressions were used to examine the excess risk associated with depression and/or anxiety for chronic physical conditions using a multivariate framework that controlled for demographic (gender, age, race/ethnicity) and modifiable lifestyle (obesity, lack of physical activity, smoking) risk factors. Bonferroni correction for multiple comparisons was applied and p ≤0.007 was considered statistically significant. RESULTS Overall, 7% had only depression, 5.2% had only anxiety and 2.5% had comorbid depression and anxiety. Results from multivariable regressions indicated that compared to individuals with no depression and no anxiety, individuals with comorbid depression and anxiety, with depression only and with anxiety only, all had higher risk of all the chronic physical conditions. ARRs for comorbid depression and anxiety ranged from 2.47 (95% CI: 1.47, 4.15; P = 0.0007) for osteoporosis to 1.64 (95% CI: 1.33, 2.04; P < 0.0001) for diabetes. Presence of depression only was also found to be significantly associated with all chronic conditions except for osteoporosis. Individuals with anxiety only were found to have a higher risk for arthritis, COPD, heart disease and hypertension. CONCLUSION Presence of depression and/or anxiety conferred an independent risk for having chronic physical conditions after adjusting for demographic and modifiable lifestyle risk factors.
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Affiliation(s)
- Rituparna Bhattacharya
- Department of Pharmaceutical Sciences and Policy, School of Pharmacy, West Virginia University, P,O, Box 9510, Morgantown, WV 26506-9510, USA.
| | - Chan Shen
- Department of Biostatistics, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Sciences and Policy, School of Pharmacy, West Virginia University, P.O. Box 9510, Morgantown, WV 26506-9510, USA,Center For Cardiovascular And Respiratory Sciences, West Virginia University, Morgantown, WV, USA
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Karavidas A, Parissis J, Arapi S, Farmakis D, Korres D, Nikolaou M, Fotiadis J, Potamitis N, Driva X, Paraskevaidis I, Matsakas E, Filippatos G, Kremastinos DT. Effects of functional electrical stimulation on quality of life and emotional stress in patients with chronic heart failure secondary to ischaemic or idiopathic dilated cardiomyopathy: A randomised, placebo-controlled trial. Eur J Heart Fail 2014; 10:709-13. [DOI: 10.1016/j.ejheart.2008.05.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 04/30/2008] [Accepted: 05/22/2008] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - John Parissis
- Second Cardiology Department and Heart Failure Unit; University of Athens Medical School, Attikon University Hospital; Athens Greece
| | - Sophia Arapi
- Cardiology Department; General Hospital “G.Genimmatas”; Athens Greece
| | - Dimitrios Farmakis
- Second Cardiology Department and Heart Failure Unit; University of Athens Medical School, Attikon University Hospital; Athens Greece
| | - Dimitrios Korres
- Cardiology Department; General Hospital “G.Genimmatas”; Athens Greece
| | - Maria Nikolaou
- Second Cardiology Department and Heart Failure Unit; University of Athens Medical School, Attikon University Hospital; Athens Greece
| | - John Fotiadis
- Cardiology Department; General Hospital “G.Genimmatas”; Athens Greece
| | | | - Xenia Driva
- Cardiology Department; General Hospital “G.Genimmatas”; Athens Greece
| | - Ioannis Paraskevaidis
- Second Cardiology Department and Heart Failure Unit; University of Athens Medical School, Attikon University Hospital; Athens Greece
| | | | - Gerasimos Filippatos
- Second Cardiology Department and Heart Failure Unit; University of Athens Medical School, Attikon University Hospital; Athens Greece
| | - Dimitrios T. Kremastinos
- Second Cardiology Department and Heart Failure Unit; University of Athens Medical School, Attikon University Hospital; Athens Greece
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Pedersen SS, Brouwers C, Versteeg H. Psychological vulnerability, ventricular tachyarrhythmias and mortality in implantable cardioverter defibrillator patients: is there a link? Expert Rev Med Devices 2014; 9:377-88. [DOI: 10.1586/erd.12.31] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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