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Published on: December 2, 2015
Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after
François Lespérance1, Nancy Frasure-Smith, Mario Talajic
1Department of Psychiatry, University of Montreal and McGill University, Canada. francois.lesperance@umontreal.ca
Insights
Depression symptoms after myocardial infarction (MI) are linked to long-term cardiac mortality. Higher initial depression levels predict worse outcomes, regardless of symptom changes over time.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Previous studies linked depression symptoms to cardiac mortality post-myocardial infarction (MI).
- Prior research did not evaluate a dose-response relationship or assess depression longitudinally.
Purpose of the Study:
- To investigate the dose-response relationship between depression symptoms and long-term cardiac mortality after MI.
- To compare the prognostic value of depression symptoms assessed during hospitalization versus at 1-year follow-up.
Main Methods:
- Administered the Beck Depression Inventory to 896 post-MI patients at admission and 1 year.
- Ascertained 5-year survival using Medicare data.
- Controlled for cardiac disease severity measures.
Main Results:
- A significant long-term dose-response relationship was observed between admission depression symptoms and cardiac mortality.
- Admission depression scores were more strongly linked to long-term mortality than 1-year scores.
- Symptom improvement only benefited patients with mild depression; higher initial scores predicted worse prognosis.
Conclusions:
- Admission depression levels are more critical for long-term survival post-MI than 1-year levels, especially for moderate to severe depression.
- Cardiovascular mechanisms linking depression to mortality may be permanent for some patients.
- Early assessment and management of depression post-MI are crucial for improving long-term cardiac outcomes.
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.
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