| Summary: | 碩士 === 國防醫學院 === 護理研究所 === 97 === Depression is four to five times as common in chronic heart failure (CHF) patients as in the general population. CHF patients with depression also had additional risks of adverse outcomes which include increasing mortality, re-hospitalization rate, and higher costs of care. Depression is often found to cause autonomic dysfunction which might help explain that depression contributes worsened outcomes. This study investigated the prevalence of depression in CHF patients and explored the relationship between the heart rate variability and depression among patients with CHF.
The study was a cross-sectional evaluation of the relationship between depressive status and cardiac autonomic function, as assessed by 24 hours heart rate variability (HRV) analysis of patients with CHF who were recruited from outpatient and inpatient cardiology clinics at medical center. Researchers used the ”Beck Depression Inventory II (BDI II)”, “Minnesota Living with Heart Failure Questionnaire(MLHFQ)”, ” Chinese Version of the Medical Outcomes Study Social Support Survey(MOS-SS-C)“, ”Mishel Uncertainty in Illness Scale(MUIS)”to evaluate patients.
Ninety-one subjects participated the study. All data were analyzed with independent t-test, One-way ANOVA, Pearson product-moment coefficient, and Generalized Linear Models, the following conclusions could be made:
1. Heart failure patients’ age was positively related to depression. Patients who were married had lower depression than other marital status patients.
2. The patients who used Amiodarone , did not use Ca-blocker, and were higher class of NYHA in heart failure, were prone to more depression.
3. Heart failure patients’ MLHFQ scores were positively related to depression. Heart failure patients who had worse quality of life were more depression.
4. Heart failure patients’ MOS-SS-C scores were negatively related to depression. Heart failure patients who lacked social support tended to be higher depression.
5. Heart failure patients’ MUIS scores were positively related to depression. Heart failure patients who had higher uncertainty in illness were more depression.
6. Heart failure patients’ age was positively related to Ln rMSSD and HF, negatively related to LF/HF. The heart rate variability of men was higher than women. And women had stronger parasympathetic activity than men.
7. The patients, who had higher ejection fraction, were lower class of NYHA, without history of diabetes or valve heart disease, used Ca-blocker, were higher SDNN and SDANN. The patients who used β-blocker were lower LF and LF/HF. The patients who used Diuretics were lower SDANN but higher HF. The patients who used ARBs were lower HF but higher SDANN and LF/HF.
8. Heart failure patients’SDNN was negatively related to depression, and MLHFQ scores . Heart failure patients who had higher depression, lower quality of life were lower SDNN.
9. Heart failure patients’ SDANN was negatively related to depression, MLHFQ scores . Heart failure patients who had higher depression, lower quality of life were lower SDANN.
10. According to Generalized Linear Models, quality of life, social support , uncertainty in illness, NYHA classifications, age and using Ca-blocker significantly explained 57.1 % of the variance in depression. Quality of life was an important factor of depression. It can explain 36.4% of the variance in depression.
11. According to Generalized Linear Models, NYHA classifications, diabetes, using diuretics, ARBs and ACEI significantly explained 52.5 % of the variance in SDNN. NYHA classification was an important factor of SDNN. It can explain 36.4% of the variance in SDNN.
12. According to Generalized Linear Models, NYHA classifications, diabetes, using ARBs and ACEI significantly explained 48.7 % of the variance in SDANN. NYHA classifications was an important factor of SDANN. It can explain 39.4% of the variance in SDANN.
In conclusion, the data provided in the article indicate that heart rate variability was correlated with depression among patients with heart failure. Our findings suggest that clinical nursing practice should develop systematic nursing instruction, case manager and patients’ support groups to improve heart rate variability and depression mood.
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