憂鬱症影響冠心症患者不良預後及生活品質

Depression Influences Poor Prognosis and Quality of Life of Patients with Coronary Artery Diseases (CAD)

憂鬱症與冠心症並列全球人類失能及社會經濟負擔的前二大疾病，受到英、美國家的重視。冠心症病發前多無預警，卻易造成身體重大損傷或致命。約20%~30%冠心症患者合併有憂鬱症，研究證實憂鬱症為冠心症之獨立危險因子，且憂鬱症可能降低冠心病患身體活動功能及生活品質，增加死亡率。但因憂鬱症症狀變異性高，合併身體化的症狀表現，增加早期診斷的困難度，而延誤治療時機。在歐美國家，冠心症的臨床醫療照護，多有進行憂鬱症篩檢，以利早期發現並介入改善，反觀台灣臨床醫療仍只著重冠心病患者的心臟症狀處置或治療，欠缺監測憂鬱症可能對冠心病患者造成之影響，故引發本文獻查證動機。經實證文獻查證發現，憂鬱症與冠心症存在共病關係，不論憂鬱症程度為何，皆可能誘發冠心症患者心臟病、提高死亡率、增加不良心臟血管事件、降低生活品質，因此我們建議有關冠心病患的臨床照護，應早期篩檢憂鬱症，以利早期確診與治療，以提升冠心病患者的照護品質。

 

Depression and Coronary Artery Disease (CAD) are the top two diseases that cause disability and socio-economic burden worldwide. The USA and the UK have paid great attention to these conditions. Although most CAD happens without any symptom, it easily causes the major physical damages or fatality for the patient. About 20% to 30% of CAD patients had depression as well. Studies show that depression is an independent risk factor for CAD. Depression may also decrease CAD patients’physical functions and quality of life, as well as increase their mortality. However, high specificity in depression symptoms complicated with physical presentations increase challenges for early depression diagnosis and therefore may delay its treatment. In the USA and European countries, the standard care for CAD patients usually includes depression screening in order to diagnosis and treat depression early. Nevertheless, care for CAD patients in Taiwan is predominately focused on cardiac symptoms management or treatments and less concerned with the potential impact of depression on patients.Therefore, we conducted a literature review on depression in CAD patients. Study results show that depression and CAD are comorbid conditions. Regardless the severity of depression, it may cause heart attack, increase mortality and adverse cardiovascular events, as well as decrease quality of life in CAD patients. Therefore, we suggest that patients with CAD be early screened for depression in order to be detected earlier and treated in time. This will improve the quality of care for CAD patients.