Factores asociados a síntomas depresivos y calidad de vida en pacientes con insuficiencia cardíaca atendidos en Centro de Consulta Externa Bucaramanga

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dc.contributor.advisorCarvajal Estupiñán, Juan Fernando
dc.contributor.advisorOchoa Vera, Miguel Enrique
dc.contributor.advisorCassiani Miranda, Carlos Arturo
dc.contributor.apolounabOchoa Vera, Miguel Enrique [miguel-enrique-ochoa-vera]spa
dc.contributor.apolounabCarvajal Estupiñán, Juan Fernando [juan-fernando-carvajal-estupiñán]spa
dc.contributor.authorCañavera Gómez, Massiel Karina
dc.contributor.cvlacCarvajal Estupiñán, Juan Fernando [0000150711]spa
dc.contributor.cvlacCassiani Miranda, Carlos Arturo [0000323632]spa
dc.contributor.googlescholarCassiani Miranda, Carlos Arturo [es&oi=ao]spa
dc.contributor.orcidCassiani Miranda, Carlos Arturo [0000-0002-2288-1027]spa
dc.contributor.researchgateCarvajal Estupiñán, Juan Fernando [Juan-Fernando-Carvajal-Estupinan-2205589613]spa
dc.contributor.researchgateCassiani Miranda, Carlos Arturo [Carlos-Arturo-Miranda]spa
dc.contributor.researchgroupGrupo de Investigaciones Clínicasspa
dc.coverage.campusUNAB Campus Bucaramangaspa
dc.coverage.spatialBucaramanga (Santander, Colombia)spa
dc.date.accessioned2023-06-29T20:46:35Z
dc.date.available2023-06-29T20:46:35Z
dc.date.issued2023-06-28
dc.degree.nameEspecialista en Medicina Internaspa
dc.description.abstractIntroducción: La enfermedad cardiovascular es la primera causa de muerte a nivel mundial, según la OMS fallecen 17,9 millones de personas cada año. Dentro de estas enfermedades cardiovasculares, la insuficiencia cardíaca (IC) toma importancia dado que es un síndrome clínico crónico con aumento en su prevalencia siendo un problema de salud pública con gran impacto en la calidad de vida afectando a más de 23 millones de personas y se espera que su prevalencia aumente un 46% del año 2012 al año 2030 . Por otra parte, la presencia de depresión y otros trastornos del estado de ánimo pueden llegar a afectar hasta el 21.5% de los pacientes con insuficiencia cardíaca, llevando a mayor compromiso de la calidad de vida teniendo en cuenta que puede llevar al desarrollo o progresión de la misma, con aumento en las tasas de hospitalización y de la mortalidad. Siendo la depresión la cuarta causa de discapacidad, teniendo impacto en la salud pública y la presencia de enfermedades crónicas aumentan el riesgo de presentación. La mayoría de estudios sobre depresión en los pacientes con IC han sido estudios descriptivos, con informes de heterogeneidad en los resultados, sin embargo, se resalta la importancia de realizar un tamizaje temprano de su presencia, lo que se convierte en un reto diagnóstico debido a que el debut de los síntomas puede sobreponer ambas entidades. Objetivo: Evaluar los factores asociados a síntomas depresivos y calidad de vida en pacientes con insuficiencia cardíaca atendidos en un centro de consulta externa de Bucaramanga en el período comprendido entre mayo y diciembre de 2021. Metodología: Estudio observacional, analítico, de corte transversal, a través de un análisis secundario de la base de datos anonimizada de pacientes con insuficiencia cardíaca atendidos en una institución de consulta externa de Bucaramanga teniendo en cuenta variables sociodemográficas, clínicas, ecocardiográficas y psicosociales para el análisis univariado y bivariado. Resultados: Se encontró que a mayor compromiso de la clase funcional NYHA (NYHA III-IV vs NYHA I-II) hay asociación estadísticamente significativa con la presencia de depresión (RP 3,33 IC951,7-6.52 p<0,001) y con el deterioro de la calidad de vida (RP 4,34 IC95 2,48 - 7,57 p=<0,001). El uso de estatinas mostró menor prevalencia de depresión (RP 0,39 IC95 0,19-,77 p=0,007) y mejor calidad de vida (RP 0,44 IC95 0,24-0,83 P=0,011). Los antecedentes asociados a prevalencia de síntomas depresivos fueron: fibrilación auricular (RP 2,13 IC95 1,06-4,29 p= 0,032) y accidente cerebrovascular (RP 3,07 IC95 1,43-6,56 p= 0,004). Todo lo anterior independiente del apoyo psicosocial. Conclusión: La depresión es una comorbilidad importante y común que a menudo coexiste en pacientes con IC y se asocia con una mala calidad de vida. Es importante evaluar los síntomas depresivos en estos pacientes con el objetivo de proporcionar un tratamiento adecuado y desde la consulta externa evitar resultados negativos.spa
dc.description.abstractenglishIntroduction: Cardiovascular disease is the leading cause of death worldwide, with 17.9 million people dying each year, according to the WHO. Among these cardiovascular diseases, heart failure (HF) is of particular importance as a chronic clinical syndrome with increasing prevalence, posing a significant public health problem with a major impact on quality of life. It affects over 23 million people, and its prevalence is expected to increase by 46% from 2012 to 2030. Furthermore, the presence of depression and other mood disorders can affect up to 21.5% of heart failure patients, leading to a further decline in quality of life. Considering that it can contribute to the development or progression of heart failure, it also increases rates of hospitalization and mortality. Depression is the fourth leading cause of disability, with implications for public health, and the presence of chronic diseases increases the risk of its occurrence. Most studies on depression in patients with heart failure have been descriptive in nature, with reports of heterogeneity in the results. However, the importance of early screening for its presence is emphasized, which poses a diagnostic challenge since the onset of symptoms can overlap between both conditions. Objective: To evaluate the factors associated with depressive symptoms and quality of life in patients with heart failure attending an outpatient clinic in Bucaramanga between May and December 2021. Methodology: This is an observational, analytical, cross-sectional study, conducted through a secondary analysis of anonymized databases of patients with heart failure attending an outpatient institution in Bucaramanga. Sociodemographic, clinical, echocardiographic, and psychosocial variables were taken into account for univariate and bivariate analysis. Results: It was found that the greater the impairment in NYHA functional class (NYHA III-IV vs. NYHA I-II), the more statistically significant the association with the presence of depression (PR 3.33, 95% CI 1.7-6.52, p<0.001) and the worse the quality of life (PR 4.34, 95% CI 2.48-7.57, p<0.001). The use of statins was associated with a lower prevalence of depression (PR 0.39, 95% CI 0.19-0.77, p=0.007) and a better quality of life (PR 0.44, 95% CI 0.24-0.83, p=0.011). The factors associated with the prevalence of depressive symptoms were atrial fibrillation (PR 2.13, 95% CI 1.06-4.29, p=0.032) and cerebrovascular accident (PR 3.07, 95% CI 1.43-6.56, p=0.004). All of these were independent of psychosocial support. Conclusion: Depression is a significant and frequently occurring comorbidity that often coexists in patients with heart failure and is linked to a diminished quality of life. Assessing depressive symptoms in these patients is crucial to offer suitable treatment and prevent adverse outcomes in the outpatient setting.spa
dc.description.degreelevelEspecializaciónspa
dc.description.learningmodalityModalidad Presencialspa
dc.description.tableofcontentsLista de Tablas........................................................................................................................... 6 Lista de Figuras ......................................................................................................................... 7 Resumen ................................................................................................................................... 8 ABSTRACT ...............................................................................................................................10 Planteamiento y Justificación del Problema ..............................................................................12 Marco Teórico ...........................................................................................................................13 Insuficiencia Cardíaca ...........................................................................................................13 Definición ...........................................................................................................................13 Clasificación .......................................................................................................................14 Epidemiología ....................................................................................................................16 Fisiopatología ....................................................................................................................19 Depresión ..........................................................................................................................20 Insuficiencia Cardiaca, Depresión y Calidad De Vida .........................................................22 Estado del Arte .........................................................................................................................25 Pregunta de Investigación .........................................................................................................30 Hipótesis ...............................................................................................................................30 Objetivos ...................................................................................................................................31 Objetivo general ....................................................................................................................31 Objetivos específicos.............................................................................................................31 Metodología ..............................................................................................................................31 Tipo de Estudio .....................................................................................................................31 Población Universo................................................................................................................32 Población Objetivo.................................................................................................................32 Criterios de Inclusión .............................................................................................................32 Criterios de Exclusión ............................................................................................................32 Muestra .................................................................................................................................32 Recolección de la Información ...............................................................................................33 Variables. ..............................................................................................................................33 Plan de procesamiento y análisis de Datos ...........................................................................34 Consideraciones Éticas .........................................................................................................35 Resultados ................................................................................................................................36 Evaluación de la Presencia de Síntomas Depresivos (Escala PHQ-9) ..................................42 Evaluación de la Calidad de Vida ..........................................................................................46 Evaluación del Apoyo Psicosocial .........................................................................................51 Insuficiencia Cardíaca: Depresión y Calidad de Vida 5 Versión final,Junio de 2023 Evaluación de asociación entre el índice de comorbilidad y los instrumentos para depresión, calidad de vida y apoyo psicosocial. ......................................................................................55 Medidas de asociación para depresión y calidad de vida ......................................................56 Evaluación de las variables y asociación con los instrumentos por puntuación .....................59 Discusión ..................................................................................................................................61 Fortalezas y Limitaciones ..........................................................................................................65 Fortalezas .............................................................................................................................65 Limitaciones ..........................................................................................................................65 Conclusiones ............................................................................................................................66 ANEXO 1 Cuestionario PHQ-9 aplicado a la población .............................................................72 Anexo 2 Cuestionario MLHFQ "Minnesota Living with Heart Failure Questionnaire" (MLHFQ) de calidad de vida en Colombia aplicado a la población ................................................................73 Anexo 3 Cuestionario de apoyo social MOS .............................................................................75 Anexo 4 Operacionalización de Variables .................................................................................76spa
dc.format.mimetypeapplication/pdfspa
dc.identifier.instnameinstname:Universidad Autónoma de Bucaramanga - UNABspa
dc.identifier.reponamereponame:Repositorio Institucional UNABspa
dc.identifier.repourlrepourl:https://repository.unab.edu.cospa
dc.identifier.urihttp://hdl.handle.net/20.500.12749/20375
dc.language.isospaspa
dc.publisher.facultyFacultad Ciencias de la Saludspa
dc.publisher.grantorUniversidad Autónoma de Bucaramanga UNABspa
dc.publisher.programEspecialización en Medicina Internaspa
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dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 2.5 Colombia*
dc.rights.localAbierto (Texto Completo)spa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/*
dc.subject.keywordsInternal medicinespa
dc.subject.keywordsMedicinespa
dc.subject.keywordsMedical sciencesspa
dc.subject.keywordsHealth sciencesspa
dc.subject.keywordsHeart failurespa
dc.subject.keywordsDepressionspa
dc.subject.keywordsQuality of lifespa
dc.subject.keywordsMental disordersspa
dc.subject.keywordsMental healthspa
dc.subject.keywordsDemographic characteristicsspa
dc.subject.lembMedicina internaspa
dc.subject.lembMedicinaspa
dc.subject.lembCiencias médicasspa
dc.subject.lembTrastornos mentalesspa
dc.subject.lembSalud mentalspa
dc.subject.lembCaracterísticas demográficasspa
dc.subject.proposalCiencias de la saludspa
dc.subject.proposalInsuficiencia cardíacaspa
dc.subject.proposalDepresiónspa
dc.subject.proposalCalidad de vidaspa
dc.titleFactores asociados a síntomas depresivos y calidad de vida en pacientes con insuficiencia cardíaca atendidos en Centro de Consulta Externa Bucaramangaspa
dc.title.translatedFactors associated with depressive symptoms and quality of life in patients with heart failure attended at the Bucaramanga Outpatient Centerspa
dc.type.coarhttp://purl.org/coar/resource_type/c_bdcc
dc.type.coarversionhttp://purl.org/coar/version/c_ab4af688f83e57aaspa
dc.type.driverinfo:eu-repo/semantics/masterThesis
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersion
dc.type.localTesisspa
dc.type.redcolhttp://purl.org/redcol/resource_type/TM

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license.txt
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Especialización en Medicina Interna
Grupo de Investigaciones Clínicas