INFLUENCE OF PSYCHOEMOTIONAL DISORDERS ON THE EFFECTIVENESS OF EDUCATION AND ACTIVE OUTPATIENT CONTROL IN HEART FAILURE PATIENTS

Aim. The influence of depression on the performance of education program and active outpatient control (the “influence”) in patients with heart failure of III-IV functional class.

Material and methods. The post-hoc analysis of the SHANS study (School and Ambulatory Observation of Heart Failure Patients), organized by the society of specialists in heart failure (SSHF), was done for the odds estimation for primary endpoints (mortality from any cause, cardiovascular hospitalization, combination endpoint — mortality and hospitalization) in patients from treatment group depending on the presence of depression sympthoms (HADS(d) >11 pts. As the subgroups of depressed and non-depressed differed by functional class and age, the correction was appliaed by the method of Mantel-Hensel for thse two parameters. Values of mean survival rate was calculated, from the moment of baseline assessment to the moment of death with further build-up of Kaplan-Meier curves.

Results. The influence showed effectiveness for the all endpoints in depression subgroups, as in non-depressed. Depressed patients reacted a little worse on the program, but there were no any statistical significance for the risk of primary endpoints. Corrected combination endpoint: non-depressed [OD =0,3806 (95% CI 0,2107-0,6876)], depressed [OR =0,4699 (95% ДИ 0,3128-0,7058)], p=0,5651. In analysis by Kaplan-Meier endowment curves it was shown that patients randomized to influence group had lower risk of death. Decrease of relative risk was higher in non-depressed [(RRR =25% (95% CI 0,61; 0,94), p<0,001)], than in depressed [(RRR =17% (95% CI 0,68; 0,99), p=0,036)]. However the effectiveness of the influence was same in both subgroups.

Conclusion. The educational and active ambulatory control program, by the secondary analysis data, showed effectiveness in patients with sympthoms of depression. For better reproducibility of such studies more precise diagnostic parameters for depression diagnostics are required.

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