Background: To evaluate whether depressive symptoms are independently predictive of mortality and hospitalization among patients with acute myocardial infarction(AMI)complicated by heart failure. Methods: The EPHESUS ...Background: To evaluate whether depressive symptoms are independently predictive of mortality and hospitalization among patients with acute myocardial infarction(AMI)complicated by heart failure. Methods: The EPHESUS trial enrolled patients with AMI complicated by heart failure. Patients from Canada, the UK, and the United States completed a Medical Outcomes Study-Depression questionnaire at baseline in addition to a comprehensive clinical examination. Cox proportional hazards regression was used to determine the relationship between depressive symptoms and outcomes, including 2-year all-cause mortality and cardiovascular death or hospitalization, adjusting for baseline clinical variables. Results: Overall, 143 of 634 patients(22.6% )had significant depressive symptoms at baseline(Medical Outcomes Study-Depression score ≥ 0.06). Depressed patients had higher 2-year mortality(29% vs 18% ; P=.004)and cardiovascular death or hospitalization(42% vs 33% ; P=.016). After risk adjustment, depressive symptoms remained significantly associated with mortality(hazard ratio 1.75, 95% CI 1.15- 2.68, P=.01)and cardiovascular death or hospitalization(hazard ratio 1.41, 95% CI 1.03- 1.93, P=.03). Results were consistent across demographic and clinical subgroups. Conclusions: Depression is an independent predictor of all-cause mortality and cardiovascular death or hospitalization after AMI complicated by heart failure. Although many factors may mediate outcomes in patients with AMI, studies are warranted to evaluate whether a depression intervention can improve survival and/or reduce hospitalizations.展开更多
文摘Background: To evaluate whether depressive symptoms are independently predictive of mortality and hospitalization among patients with acute myocardial infarction(AMI)complicated by heart failure. Methods: The EPHESUS trial enrolled patients with AMI complicated by heart failure. Patients from Canada, the UK, and the United States completed a Medical Outcomes Study-Depression questionnaire at baseline in addition to a comprehensive clinical examination. Cox proportional hazards regression was used to determine the relationship between depressive symptoms and outcomes, including 2-year all-cause mortality and cardiovascular death or hospitalization, adjusting for baseline clinical variables. Results: Overall, 143 of 634 patients(22.6% )had significant depressive symptoms at baseline(Medical Outcomes Study-Depression score ≥ 0.06). Depressed patients had higher 2-year mortality(29% vs 18% ; P=.004)and cardiovascular death or hospitalization(42% vs 33% ; P=.016). After risk adjustment, depressive symptoms remained significantly associated with mortality(hazard ratio 1.75, 95% CI 1.15- 2.68, P=.01)and cardiovascular death or hospitalization(hazard ratio 1.41, 95% CI 1.03- 1.93, P=.03). Results were consistent across demographic and clinical subgroups. Conclusions: Depression is an independent predictor of all-cause mortality and cardiovascular death or hospitalization after AMI complicated by heart failure. Although many factors may mediate outcomes in patients with AMI, studies are warranted to evaluate whether a depression intervention can improve survival and/or reduce hospitalizations.
