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Am J Cardiol ; 124(5): 746-750, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31277789

RESUMO

Beta blockers reduce mortality and morbidity in patients with heart failure. Early reports linking ß-blockers with depression may have limited their use in heart failure patients with co-morbid depression. Although more recent studies have challenged the association between ß-blocker therapy and depression, patient and physicians remain concerned. The goal of this study is to evaluate the utilization and outcomes of ß-blocker therapy in heart failure patients with depression. This is a retrospective cohort study of patients at a multicenter integrated healthcare system with a diagnosis of heart failure from 2008 to 2014. Among 6,915 patients with heart failure with left ventricular ejection fraction of <50%, 1,252 (18.1%) had a diagnosis of depression. Patients with depression were more likely to be women and had a higher prevalence of cardiovascular risk factors. Depression was associated with decreased odds of ß-blocker treatment (adjusted odds ratio [OR], 0.77; 95% confidence interval [CI], 0.62 to 0.95; p = 0.016). During a mean follow-up of 2.6 years, 439 (35.1%) patients with depression died compared with 1,549 (27.4%) patients without depression. Depressed patients not treated with ß-blocker had higher mortality compared with nondepressed patients (adjusted hazard ratio [HR], 1.4, 95% CI 1.09 to 1.7, p = 0.005). When treated with ß-blockers, their risk of mortality was attenuated (HR 1.1, 95% CI 0.97 to 1.2, p = 0.14). In conclusion, ß-blocker therapy remains underutilized in heart failure patients with depression, and its underutilization contributes to the reduced survival rate observed in this cohort.


Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Transtorno Depressivo/epidemiologia , Uso de Medicamentos/estatística & dados numéricos , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/epidemiologia , Antagonistas Adrenérgicos beta/efeitos adversos , Distribuição por Idade , Idoso , Causas de Morte , Estudos de Coortes , Comorbidade , Bases de Dados Factuais , Transtorno Depressivo/fisiopatologia , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Revisão da Utilização de Seguros , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Volume Sistólico , Análise de Sobrevida , Estados Unidos
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