Relationship of Depression to Increased Risk of Mortality and Rehospitalization In Patients With CHF (original) (raw)
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Effect of Depression on Late (8 years) Mortality After Myocardial Infarction
The American Journal of Cardiology, 2008
Depression during hospitalization for myocardial infarction (MI) is associated with subsequent mortality, but whether this risk persisted long term is not well studied. This study was performed to determine whether depression during hospitalization for MI, which predicted mortality at 4 months, predicted mortality 8 years later. This was a prospective observational study of 284 hospitalized patients with MI. Major depression and dysthymia were assessed using structured interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, and depressive symptoms, using the Beck Depression Inventory. Mortality was determined using the Social Security Death Index. Mean age during MI hospitalization was 64.8 years, 43.0% of patients were women, 66.7% had hypertension, and 35.7% had diabetes mellitus. Any depression (major depression, dysthymia, and/or Beck Depression Inventory score >10) was present in 76 patients (26.8%). The 8-year mortality rate was 47.9% (136 deaths). Any depression at the time of MI was not associated with mortality at 8 years in unadjusted (hazard ratio 1.25, 95% confidence interval 0.87 to 1.81, p ؍ 0.22) or multivariate models (hazard ratio 0.76, 95% confidence interval 0.47 to 1.24, p ؍ 0.27). In conclusion, depression after MI was associated with increased short-term mortality, but its relation with mortality over time appeared to wane, at least in a group of older patients who had multiple co-morbidities.
Depression and heart failure in patients with a new myocardial infarction
American Heart Journal, 2005
Background Heart failure (HF) is a disabling chronic illness that is increasing in prevalence. Despite advances in its medical treatment, little is known about its psychosocial correlates. This investigation compared the prevalence of depression in patients with and without HF who were hospitalized with myocardial infarction (MI) and also at high psychosocial risk.
Depression follows myocardial infarction
Original Article Unfortunately, depression is now a well documented independent risk factor of coronary artery disease. Post-myocardial infarction (MI) patients with a clinician-diagnosed depressive disorder or self-reported depressive symptoms carry a 2.0-to 2.5-fold increased relative risk of new cardiovascular events and cardiac mortality Questions about the pathophysiologic mechanism of depression in this setting are paralleled by uncertainties about the optimal treatment of depression for patients recovering from a myocardial infarction and by a lack of knowledge about whether treating depression lowers the associated increased mortality risk. Ongoing research studies will help to determine the benefits of psychosocial interventions and of antidepressant therapy for patients soon after myocardial infarction. Although the identification of depression as a risk factor may by itself be a reason to incorporate a comprehensive psychological evaluation into the routine care of patients with myocardial infarction. This practice should certainly become standard if studies show that treating depression reduces the increased mortality risk of these patients. Treatment with selective serotonin reuptake inhibitors (SSRIs) significantly improved outcome of what one can become a major catastrophe (Jonge et al). Although non-randomized trial, this could essentially relate to intrinsic pharmacologic properties of SSRIs causing, for example, restoration of subtle platelet hyperactivity in the depressed. Clearly, before another clinical trial of depression treatment is initiated in post-MI populations, we need more information on the " cardio toxic " subtypes of depression. But the query still persists. Keeping all these chronic outbursts in mind a study was conducted on indoor and outdoor patients attending or admitted in GGS Medical College & Hospital, Faridkot. 67 MI diagnosed and treated patients attending the post MI clinics were interviewed for symptoms of depression. We investigated if there are differences in pre-and post-MI characteristics between these subtypes. Persons who are depressed and who have pre-existing cardiovascular disease have a 3.5 times greater risk of death than patients who are not depressed and have cardiovascular disease. A comparison was made between first-ever and ongoing or recurrent depression on demographic and cardiac data, personality, and depression characteristics Results: Approximately 165 percent of patients with acute myocardial infarction report experiencing symptoms of depression in a structured study. Major depression is present in 15 to 22 percent of these patients. Depression is an independent risk factor in the development of and mortality associated with cardiovascular disease in otherwise healthy persons. Cognitive-behavior therapy is the preferred psychological treatment. Selective serotonin reuptake inhibitor antidepressants are the recommended pharmacologic treatment because of the relative absence of effects on the cardiovascular system. The combination of a selective serotonin reuptake inhibitor with cognitive-behavior therapy is often the most effective treatment for depression in patients with cardiovascular disease.
Depression and Congestive Heart Failure
Congestive Heart Failure, 2003
The prevalence rates of depression in congestive heart failure patients range from 24%-42%. Depression is a graded, independent risk factor for readmission to the hospital, functional decline, and mortality in patients with congestive heart failure. Physicians can assess depression by using the SIG E CAPS + mood mnemonic, or any of a number of easily administered and scored self-report inventories. Cognitive-behavior therapy is the preferred psychological treatment. Cognitive-behavior therapy emphasizes the reciprocal interactions among physiology, environmental events, thoughts, and behaviors, and how these may be altered to produce changes in mood and behavior. Pharmacologically, the selective serotonin reuptake inhibitors are recommended, whereas the tricyclic antidepressants are not recommended for depression in congestive heart failure patients. The combination of a selective serotonin reuptake inhibitor with cognitive-behavior therapy is often the most effective treatment. (CHF. 2003;9:163-169) Major depression has been reported in 15%-22% of patients suffering from acute cardiovascular disease, with as many as 65% reporting some symptoms of depression. 1 Further, depression has been well established as an independent risk factor contributing to poorer outcome and mortality in patients with coronary heart disease. The relationship between depression and congestive heart failure (CHF) has only recently been examined. Somewhere between 2 and 3 million Americans suffer from CHF. 5,6 Approximately 400,000 new cases of CHF are diagnosed each year. 7 The prevalence rates of depression in CHF samples range from 24%-42%. Vaccarino et al. 10 found that 35%, 33.5%, and 9% of a sample of CHF patients 50 years of age or older reported mild, moderate, or severe depression, respectively. Jiang and colleagues 11 reported that 13.9% of 374 CHF patients 18 years or older met criteria for a major depressive disorder, while 35.3% of the sample reported Beck depression scores of 10 or higher.
Comorbid Depression and Heart Failure: A Community Cohort Study
Objective To examine the association between depression and clinical outcomes in heart failure (HF) in a community cohort. Patients and Methods HF patients in Minnesota, United States completed depression screening using the 9-item Patient Health Questionnaire (PHQ-9) between 1 st Oct 2007 and 1 st Dec 2011; patients with PHQ-95 were labelled " depressed ". We calculated the risk of death and first hospitalization within 2 years using Cox regression. Results were adjusted for 10 commonly used prognostic factors (age, sex, systolic blood pressure, estimated glomerular filtration rate, serum sodium, ejection fraction, blood urea nitrogen, brain natriuretic peptide, presence of diabetes and ischaemic aetiology). Area under the curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) compared depression as a predictor against the aforementioned factors. Results 425 patients (mean age 74, 57.6% males) were included in the study; 179 (42.1%) had PHQ-95. The adjusted hazard ratio of death was 2.02 (95% CI 1.34–3.04) and of hospitalization was 1.42 (95% CI 1.13–1.80) for those with compared to those without depression. Adding depression to the models did not appreciably change the AUC but led to statistically significant improvements in both the IDI (p = 0.001 and p = 0.005 for death and hospitalization , respectively) and NRI (for death and hospitalization, 35% (p = 0.002) and 27% (p = 0.007) were reclassified correctly, respectively). Conclusion Depression is frequent among community patients with HF and associated with increased risk of hospitalizations and death. Risk prediction for death and hospitalizations in HF patients can be improved by considering depression.
Depression and five year survival following acute myocardial infarction: A prospective study
Journal of Affective Disorders, 2008
Background-Depression has been shown to be a risk factor for mortality during the 12 months following an acute myocardial infarction (MI), but few studies have examined whether it is associated with increased risk over longer periods. Most of the existing studies utilized depression questionnaires rather than diagnostic interviews, the gold standard for clinical depression diagnosis. The purpose of this study was to determine whether interviewed-diagnosed clinical depression affects survival for at least 5 years after an acute MI.
Background-Although previous research demonstrated an independent link between depression symptoms and cardiac mortality after myocardial infarction (MI), depression was assessed only once, and a dose-response relationship was not evaluated. Methods and Results-We administered the Beck Depression Inventory to 896 post-MI patients during admission and at 1 year. Five-year survival was ascertained using Medicare data. We observed a significant long-term dose-response relationship between depression symptoms during hospitalization and cardiac mortality. Results remained significant after control for multiple measures of cardiac disease severity. Although 1-year scores were also linked to cardiac mortality, most of that impact was explained by baseline scores. Improvement in depression symptoms was associated with less cardiac mortality only for patients with mild depression. Patients with higher initial scores had worse long-term prognosis regardless of symptom changes. Conclusions-The level of depression symptoms during admission for MI is more closely linked to long-term survival than the level at 1 year, particularly in patients with moderate to severe levels of depression, suggesting that the presumed cardiovascular mechanisms linking depression to cardiac mortality may be more or less permanent for them.
Depression increasingly predicts mortality in the course of congestive heart failure
European Journal of Heart Failure, 2005
Background: Congestive heart failure (CHF) is frequently associated with depression. However, the impact of depression on prognosis has not yet been sufficiently established. Aims: To prospectively investigate the influence of depression on mortality in patients with CHF. Methods: In 209 CHF patients depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D). Results: Compared to survivors (n=164), non-survivors (n=45) were characterized by a higher New York Heart Association (NYHA) functional class (2.8F0.7 vs. 2.5F0.6), and a lower left ventricular ejection fraction (LVEF) (18F8 vs. 23F10%) and peakVO 2 (13.1F4.5 vs. 15.4F5.2 ml/kg/min) at baseline. Furthermore, non-survivors had a higher depression score (7.5F4.0 vs. 6.1F4.3) (all Pb0.05). After a mean follow-up of 24.8 months the depression score was identified as a significant indicator of mortality ( Pb0.01). In multivariate analysis the depression score predicted mortality independent from NYHA functional class, LVEF and peakVO 2 . Combination of depression score, LVEF and peakVO 2 allowed for a better risk stratification than combination of LVEF and peakVO 2 alone. The risk ratio for mortality in patients with an elevated depression score (i.e. above the median) rose over time to 8.2 after 30 months (CI 2.62-25.84). Conclusions: The depression score predicts mortality independent of somatic parameters in CHF patients not treated for depression. Its prognostic power increases over time and should, thus, be accounted for in risk stratification and therapy.