Relationship of Depression

8/9/2019 Relationship of Depression

1/12

Relationship of Depression, Anxiety, and Social Isolation to Chronic

Heart Failure Outpatient Mortality

Erika Friedmann, PhDa,b; Sue A. Thomas, RN, PhD, FAAN a; Fang Liu, MSa; Patricia . Morton, RN,PhD, !ANP, FAANa; Deborah !ha"a, RN, MS, !RNPa; Ste"hen S. ott#ieb, MD, FA!!c Am Heart J. 2006;152(5):940.e1-940.e8. ©2006 Mosby, I!."oste# 01$%0$200&

Abstract and $ntroduction

Abstract

%b&ecti'es( 'e "sy!oso!a* +a!tors t!ome t#y ("+) /estate# te re/a*e!e o#eresso a# a3ety a# te re*atos o sy!oso!a* a!tors to morta*ty otatets t earta*re (H+).)ackground( os#erab*e e/#e!e *s sy!oso!a* a!tors to !oroary eart #sease morta*ty a#s##e !ar#a! #eat (7). 'e !otrbto o sy!oso!a* a!tors #ee#et o #sease se/ertyto H+ otatet morta*ty s ot e** e*!#ate#.Methods( "atets ( 15%) rom 20 ##e ar#a! 7eat Heart +a*re 'ra* (7-He+') stesart!ate# te "+. 7-He+' ro/#e# #emora!, me#!a* story, a# !ar#a! #ata."art!ats !om*ete# estoares to assess sy!oso!a* stats at "+ etry.Resu#ts( 7eresso a# a3ety ere !ommo H+ otatets (%6 P .04, a?ar# rato (H@) 1.81 a# so!a* so*ato (P .04, H@ 2.25), bt ot a3ety, re#!te# morta*ty #ee#et o#emora!s, !*!a* re#!tors, a# treatmet. Be sm*taeos*y !*# s!at#emora!, !*!a*, a# sy!oso!a* re#!tors a# treatmet ros, #eresso (*) (P .022, H@ 2.2) a# so!a* so*ato (P .094, H@ 1.&5) re#!te# morta*ty. A**-!ase morta*ty as 12 or#eresse# atets a# 9 or oters.

!onc#usion( 's st#y #s a re/a*e!e o a3ety a# !orms te re/a*e!e o#eresso te H+ otatet o*ato. 7eresso a# so!a* so*ato re#!te# morta*ty#ee#et o #emora! a# !*!a* stats H+ otatets.

$ntroduction

os#erab*e e/#e!e *s sy!oso!a* a!tors s! as #eresso,>1-5 a3ety,>2,4-6 *e stress,>2,&-9 so!a*so*ato,>%-5,10 a# *a! o et oers>11-1% to !oroary eart #sease (H7) morta*ty a# s##e!ar#a! #eat (7). "re/os st#es a/e #o!mete# a asso!ato betee #eresso a#morta*ty otatets t eart a*re (H+),>14-1& atets t H+,>18 a# osta*?e# atets t H+.>19,20 'e morta!e o te oter sy!oso!a* a!tors morta*ty o otatets t H+ o are otaat !ar#a! tras*atato as ot bee e** e/a*ate#.

'e "sy!oso!a* +a!tors t!ome t#y ("+) ##e ar#a! 7eat as te rst st#y toe3ame te #ee#et !otrbtos o sy!oso!a* a!tors a# #sease se/erty to morta*ty H+otatets. Be yotes?e# tat #eresso, a3ety, *e stress, so!a* so*ato, a# *a! o etoers, te sy!oso!a* a!tors tat are asso!ate# t !oroary eart #sease rooss, o*#a*so be re*ate# to morta*ty #ee#et o #emora! a# !*!a* stats or H+ otatets.

Methods

A** ##e ar#a! 7eat Heart +a*re 'ra* (7-He+') stes ere /te# to art!ate te "+;20 stes !om*ete# ma sbCe!ts aro/a*, se# !otra!ts, a# !otrbte# at *east 1 atet. tesart!at "+ ere *o!ate# te Dte# tates ( 18), aa#a ( 2), a# e Eea*a# ( 1). "+ starte# ater 7-He+' re!rtmet a# be. 7-He+' art!ats o erera#om?e# to te a*ty o * e sbst#y o 7-He+' ere e3!*#e# be!ase o !o!ers abotatet br#e. "atets o etere# 7-He+' ater "+ bea or retre# or 7-He+' o**o-a# o !o*# rea# a# rte F*s ere e*b*e to art!ate. earate orme# !oset asrere# or te "+.


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7-He+' art!ats a# e Gor Heart Asso!ato (GHA) !*ass II or III H+ a# *et /etr!*areCe!to ra!to (F+) %5, a# ere ra#om*y asse# to m*atab*e !ar#o/erter #ebr**ator (I7),amo#aroe, or *a!ebo me#!ato. 7-He+' !*so a# e3!*so !rtera a# re!rtmetmeto#s are b*se# e*seere.>21 7-He+' ro/#e# #emora! a# ea*t #ata.

"art!ats !om*ete# estoares to assess sy!oso!a* stats !*# #eresso, a3ety,so!a* sort, et oers, a# *e stress at "+ etry ater 1 mot a# e/ery 6 mots."er!etos o marmet H+-se!! !toa* stats as assesse# beore ra#om?ato a# at 6-mot ter/a*s.

$nstruments

'e tate 'rat A3ety I/etory ('AI), ! as e**-estab*se# /a*#ty a# re*ab*ty,>22 as se# toassess a3ety. "atets t s!ores 40 are !*asse# as a3os.>2% 25 'e o!a* @ea#Cstmet @at !a*e, a !e!*st o re!et *e e/ets, as se#to e/a*ate atetsK *e stress te *ast 6 to 12 mots a# e3e!tatos o stress te e3t 6mots. I#/#a*s !e! ea! o 46 *e e/ets, ost/e or eat/e, o!!rr #r te se!e#ero#.>26 'est-retest re*ab*ty as estab*se#.>8 "et oers as assesse# t 5 #emora!-tyeestos.>2&

"er!e/e# marmet H+-se!! !toa* stats as assesse# t te Mesota L/ t H+!a*e (MLBH+). It !*#es 21 estos measr te atetKs er!eto o ys!a* a#sy!oso!a* ma!t o H+-re*ate# symtoms a# treatmets a#*ts. >28,29 Her s!ores #!ate tatatets er!e/e more marmet.

Data Ana#*sis

2 'ests a# oe-ay aa*yses o /ara!e ere se# to e3ame #ere!es #emora! a#me#!a* story /arab*es amo atets te 7-He+' treatmets. 21 A ror e3e!tatos tat a3ety, #eresso, !toa* marmet, be #abet!, o*#er, GHA!*ass III H+, a/ a story o myo!ar#a* ar!to, a# re!e/ *a!ebo me#!ato o*# beasso!ate# t orse sr//a* a# er F+, a# so!a* sort o*# be asso!ate# t bettersr//a* ere teste# t 1-ta*e# tests. @a!e a# se3 ere teste# t 2-ta*e# tests.

Resu#ts

tes !otrbte# rom 1 to 19 atets (me#a 5). 'rtee stes !otrbte# & atets.

"atets ere *are*y me a# te. Aes rae# rom %5.5 to 85.1 years. +tee atets #e# #ra o**o- o 1.6 to 49.2 mots, a 9.8 a**-!ase morta*ty rate. r//ors ere o**oe# or at *east1 year (me#a 2& mots). 7-He+' morta*ty as 26.4 t a mmm o**o- o 24 mots(me#a 54.5 mots). "atets ( 15%) etere# "+ 0 to 54.4 mots ater tey etere# te 7-

He+' (mea 1&.5 mots; 7 16.0). La betee 7-He+' a# "+ etres as N1 mot or 4&atets, 1-12 mots or 21 atets, a# 1 year or 85 atets. +or #emora! a# me#!a* storyormato or "+ a# 7-He+', see 'ab*e 1 .

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mmares o sy!oso!a* measres at ta* assessmet are 'ab*e 2 . ee# #strbtos o#eresso, so!a* sort amot, so!a* sort satsa!to, ast *e e/ets, a# tre *e e/etse!esstate# *oartm! trasormatos (*), ! eerate# orma* #strbtos. 'rasorme#/arab*es >#ete# t O(*)O s3 ere se# or arametr! aa*yses.

'e #emora!, !*!a*, a# sy!oso!a* !ara!terst!s o te "+ art!ats rom te 7-He+' treatmet ros ## ot #er s!at*y. I /arate aa*yses, morta*ty ## ot #ers!at*y amo "+ art!ats te treatmet (*a!ebo 6$51, 11.8; amo#aroe %$45, 6.&;a# I7 6$5&, 10.5). 7ete!t #ere!es treatmet ro morta*ty rere# a *arer sam*e.>21

Ps*chosocia# Distress

r (1%8) 0.4%8, P N .001 a# state a3ety >r (1%1) 0.421, P N .001 bt ot so!a* sort amot

>r (144) .0%9, P .60. "atets t more !toa* marmet ere more #eresse# a# morea3os.

Time to E'ent Ana#*sis

'e !otrbto o ea! #emora!, !*!a*, a# sy!oso!a* /arab*e, *a tme a# er!e/e# H+-se!! !toa* stats to morta*ty beyo# te ee!t o treatmet ro as e3ame# /a o3reresso (see 'ab*e % ). I ea! aa*yss, te #mmy /arab*es or treatmet ro t *a!ebo as tereere!e ro a# te re#!tor ere etere# sm*taeos*y. 7emora! a# !*!a* re#!tors omorta*ty (P N .20) !*#e# o*#er ae, atra* br**ato$*tter, #abetes, *oer F+, a# GHA !*ass."sy!oso!a* re#!tors o morta*ty (P N .20) !*#e# a3ety, #eresso, a# so!a* so*ato."er!e/e# marmet H+ se!! !toa* stats re#!te# morta*ty (P N .2) a# as !*#e# tsy!oso!a* a!tors as t assesses er!etos rater ta ys!a* !to or !*!a* !ara!terst!s.Ha?ar# !to ras or te re*atos o #eresso, a3ety, a# so!a* sort to morta*ty are

!*#e# +re 1, +re 2, a# +re %.

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Figure .

m*at/e a?ar# !tos !omar atets o s!ore# be*o te me#a (N10) a# tose o areabo/e te me#a (=10) o te


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Figure 0.

m*at/e a?ar# !tos !omar atets o reort be*o me#a a# abo/e me#a amotso so!a* sort o te -6.

'e #emora! a# !*!a* re#!tors o morta*ty (P N .20) beyo# te ee!t o treatmet ro ereetere# sm*taeos*y t treatmet ro to a o3 reresso mo#e*. Atra* br**ato$*tter a#GHA !*ass ere s!at #ee#et re#!tors o morta*ty (see 'ab*e 4 ). Be *a tme asetere# to te mo#e*, t ma#e o s!at !otrbto to sr//a* or sbstat/e !ae te#s. "atets t atra* br**ato or *tter a# GHA !*ass III H+ ere s!at*y more *e*y to#e ta tose t ss rytm a# GHA !*ass II H+, #ee#et o te ee!ts o treatmet roa# #abet! stats.

Fa! o te % sy!oso!a* /arab*es tat re#!te# morta*ty beyo# te ee!t o treatmet ro a#MLBH+ as etere# t atra* br**ato$*tter, GHA !*ass, a# treatmet ro to a o3reresso mo#e*. I tese mo#e*s, #eresso > 1%6, a?ar# rato (H@) 2.25, I 1.04&-4.&28, P .04) a# so!a* so*ato ( 145, H@ 0.55, I 0.418-0.949, P .0%6) ere s!at #ee#etre#!tors o morta*ty; a3ety ( 149, H@ 1.0%, I 0.989-1.0&2, P .12) a# MLBH+ ( 1%5, [email protected], I 0.990-1.041, P .16) ere ot.

'e sy!oso!a*, #emora!, a# !*!a* /arab*es re#!t morta*ty (P N .20) rom te searateaa*yses ere te !ombe# as re#!tors o morta*ty. A seres o aa*yses res*te# te a* mo#e*(see 'ab*e 5 ). I ts mo#e*, #eresso as a s!at #ee#et re#!tor o morta*ty, a# so!a*so*ato te#e# to re#!t morta*ty, #ee#et o #emora! a# !*!a* stats, treatmet ro,a# ea! oter. Be *a tme as etere# to te mo#e*, t ma#e o s!at !otrbto to sr//a*or sbstat/e !ae te #s. "atets o ere more #eresse# a# more so!a**y so*ate#ere more *e*y to #e.

Discussion

's st#y #s a re/a*e!e o a3ety a# !orms te re/a*e!e o #eresso te H+otatet o*ato. 7eresso a# so!a* so*ato re#!te# morta*ty #ee#et o #emora!a# !*!a* stats a# ea! oter ts o*ato. Beter #eresso a# a3ety re*e!t orse H+or !ase !aes tat !rease morta*ty s ot o. 'e sy!oso!a* /arab*es are ot ro3es ors!ema or eCe!to ra!to. 'e #s o te reset st#y sest tat tese sy!oso!a* a!tors!o*# be !asat/e. %0 May st#es

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#o!mete# #eresso a!te H+,>18,20 a#, !reas*y, st#es so #eresso a *areroorto o atets t !ro! H+.>%1 'e re/a*e!e o #eresso ts st#y may be a#erestmate o te tre re/a*e!e amo H+ otatets. 'e #ema#s o a *are !om*e3 !*!a*tra* s! as 7-He+' may #s!orae #eresse# atets rom art!at.

m*ar to st#es o #eresso osta*?e# atets, e o# #eresso re/a*et !ro! H+otatets. 'e re/a*e!e o #eresso s *e*y to !rease as te #rato o H+ !reases.Ha/rae et a*>%2 #emostrate# rose!t/e*y tat 21 o H+ otatets o are ot #eresse# at rstassessmet ere #eresse# 1 year *ater.

I te o*y re/os st#y o a3ety H+ otatets ot aat tras*atato, te ome tet#es o Let Qetr!*ar 7ys!to (LQ7) tra* a# orse "ro*e o Moo# tates a3ety s!oresta a ormat/e sam*e; me ## ot.>%% A3ety o!!rre# 45 o H+ otatets art!at te!rret st#y: 54 o te ome a# 4% o te me. r #s sest tat a3ety s!ores H+otatets (mea %6.&) are sm*ar to oter atets t !ro! eart #sease.>2,%4 I te !rret st#y,a3ety as more ta 1.5 tmes as reet H+ otatets as te Ja et a* st#y o atetst H+.>19 'e !ases o a3ety may #er or atets o are !ro! a# a!te H+, or otatetsmay be more a3os abot ter H+ be!ase tey are *ess !o#et abot ter !are ta atets.

Predictors o- Morta#it*

I te !rret st#y, te o3 reresso !*# o*y #/#a* sy!oso!a* re#!tors a# treatmetro #mmy /arab*es seste# tat #eresso, state a3ety, a# so!a* so*ato amot re#!tmorta*ty H+ otatets. 14-16 o 119 stab*eH+ otatets, a# te +ars et a* st#y>1& o %96 os!em! H+ otatets. 7eresso a*so re#!tsmorta*ty H+ atets>18 a# osta*?e# atets o a/e H+.>19,20 7eress/e symtoms are astro re#!tor o orse H+ ea*t stats.>%5 7eresso s reorte# more reet*y t te %6 Hoe/er, te #ee#et ma!t o #eresso a#

!*!a* se/erty or m*t/arate aa*yss #!ates tat #eresso !otrbtes beyo# te !otrbtoo H+ symtoms. A !rease o 1 te atra* *o o te #eresso s!a*e !rease# te rs o #y2.%5 tmes. "atets t m*#, mo#erate, a# se/ere #eresso ere 2.2, %.0, a# 5.4 tmes as *e*y to#e as tose o ere ot #eresse# base# o te o3 #eresso mo#e* a# 19

'e !o!eta*?ato o so!a* sort !a ae!t ts re*atos to morta*ty. Be o# tat te mber

o eo*e te atets !o*# as or sort stress* statos as a re#!tor o sr//a* otatets #ee#et o #emora! a# !*!a* stats a# te# to be #ee#et o#eresso. 'e terre*atos o #eresso a# so!a* so*ato s !osstet t H+ otatetso */e a*oe a/ a er *e*oo# o #e/e*o #eresso t 1 year.>%2 Fmotoa* sort(mber o eo*e a/a*ab*e to ta* o/er rob*ems) as a #ee#et re#!tor o morta*ty t 1year atets osta*?e# or H+ ater !otro** or #emora!s, !*!a* stats, a# #eresso.>%& o!a* so*ato as re*ate# to morta*ty H+ otatets ater !otro** or #eresso a# H+se/erty.>14 I te same st#y, er!e/e# so!a* sort #ee# as te *e*oo# o re!e/ e* romoters #r **ess as ot re*ate# to morta*ty. m*ar*y, or st#y e3e!tatos o satsa!to tso!a* sort re!e/e# rom oters as ot re*ate# to morta*ty.

H+, #eresso a# a3ety !*#e !ommo symtoms a# yera!t/ty o te symatoa#rea*-me#**a system, te yota*am!-ttary-a#rea* a3s, a# aborma* *ate*et rea!t/ty.>45 's,estab*s a !asa* re*atos betee #eresso a# H+ o*# rere *ot#a* aa*yss o

bot sy!o*o! a# yso*o! stats.


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'e sma** sam*e a# *o morta*ty te !rret st#y *mte# te mber o /arab*es e3ame# a#te oer o or #s. A##toa* /arab*es may a/e ma#e s!at !otrbtos to morta*ty a*arer st#y.


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Afib, atra* br**ato or *tter; ACE , aotes-!o/ert e?yme; ARB, atotes II re!etorb*o!er.

Tab#e /. Ps*chosocia# Status o- the Patients at First Assessment -or a## PF%SPartici"ants 2N 3 405 and -or Partici"ants Randomi6ed to Recei'eAmiodarone 2n 3 745, $!D 2n 3 485, or P#acebo 2n 3 45

STAI , state a3ety; BDI-II , #eresso; SSSAT , satsa!to t so!a* sort; SSAMT , so!a* sortamot; PLE , mber o stress* *e e/ets te ast; FLE , mber o stress* *e e/ets e3e!te# tre.


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Tab#e 0. Summar* o- !o1 Regression Mode#s 9sing $ndi'idua# )ase#ine Predictorsand Treatment rou" to Predict Morta#it*

Afib, atra* br**ato$*tter; FLE , mber o stress* *e e/ets e3e!te# tre; ln, atra* *otrasorme#; SSAMT , so!a* sort amot; SSSAT , satsa!to t so!a* sort; *a tme reere!ero s N1 mot.R'o-ta*e# robab*ty, o a ror #re!toa* yotess.S95 I.Te-ta*e# robab*ty, ooste o re#!te# #re!to.

Tab#e 7. !o1 Regression Mode# Predicting Morta#it* From Demogra"hic and!#inica# Predictors and Treatment rou" 2N 3 405


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"*a!ebo s te reere!e ro or treatmet ro !omarsos.

Tab#e 4. !o1 Regression Mode# Predicting Morta#it* From Demogra"hic and!#inica# :ariab#es, De"ression, Socia# Su""ort Amount and Treatment

rou" 2n 3 0/5

"*a!ebo s te reere!e ro or treatmet ro !omarsos.

Re-erences

1. */erstoe "H. 7eresso a# ot!ome a!te myo!ar#a* ar!to.


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15. Mrber 'A,


12/12

Fra +re#ma, "7, !oo* o rs, D/ersty o Mary*a#, 655 B Lombar# t,

Documents

Relationship of Depression