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Elevated depression symptoms predict long-term cardiovascular mortality in patients with atrial fibrillation and

Nancy Frasure-Smith1, François Lespérance, Martine Habra

  • 1Montreal Heart Institute Research Centre, Montreal, Quebec, Canada. nancy.frasure-smith@umontreal.ca

Circulation
|July 1, 2009
PubMed

Insights

Depression significantly increases cardiovascular death risk in patients with both atrial fibrillation (AF) and congestive heart failure (CHF). Unmarried patients with depression face the highest mortality risk, highlighting the need for further research.

Area of Science:

  • Cardiology
  • Psychiatry
  • Clinical Research

Background:

  • Depression is a known predictor of poor outcomes in cardiac conditions like congestive heart failure (CHF).
  • The prognostic impact of depression in patients with comorbid atrial fibrillation (AF) and CHF remains understudied.
  • This substudy analyzed data from the AF-CHF Trial, focusing on patients with reduced ejection fraction, CHF symptoms, and AF history receiving optimal medical care.

Purpose of the Study:

  • To investigate whether depression predicts long-term cardiovascular mortality in patients with coexisting AF and CHF.
  • To assess the association between depression and different causes of death, including cardiovascular, arrhythmic, and all-cause mortality.
  • To examine the combined risk of depression and marital status on mortality in this patient population.

Main Methods:

  • Utilized data from 974 participants in the AF-CHF Trial substudy.
  • Assessed depression symptoms using the Beck Depression Inventory-II (BDI-II), with elevated scores defined as BDI-II >= 14.
  • Employed Cox proportional hazards models, adjusting for multiple prognostic factors, to analyze the relationship between depression and mortality outcomes over a mean follow-up of 39 months.

Main Results:

  • 32.0% of participants exhibited elevated depression scores.
  • Elevated depression scores significantly predicted cardiovascular mortality (HR 1.57), arrhythmic death (HR 1.69), and all-cause mortality (HR 1.38).
  • The risk associated with depression and marital status was additive, with unmarried depressed patients facing the highest risk.

Conclusions:

  • Elevated depression symptoms are independently associated with increased cardiovascular mortality in patients with comorbid AF and CHF, even with optimized treatment.
  • Unmarried status further elevates mortality risk in depressed patients with AF and CHF.
  • Further investigation into the mechanisms underlying this association and potential treatment strategies is warranted.
Abstract

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