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Depressive Symptoms and Risk for Sudden Cardiac Death in Stable Coronary Artery Disease
Minna Lahtinen1, Antti M Kiviniemi2, M Juhani Junttila2
1Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.
Insights
Depression symptoms significantly increase the risk of sudden cardiac death (SCD) in stable coronary artery disease (CAD) patients. Screening for and treating depression is crucial for managing cardiac risk.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- The link between depression and mortality in stable coronary artery disease (CAD) patients remains unclear.
- Understanding the specific modes of death associated with depressive symptoms is essential for targeted interventions.
Purpose of the Study:
- To investigate the association between depressive symptoms and various modes of death, including all-cause mortality, noncardiac death, sudden cardiac death (SCD), and non-SCD.
- To determine if depressive symptoms predict SCD independently of traditional cardiovascular risk factors.
Main Methods:
- A cohort of 1,928 patients with angiographically documented CAD were assessed for depressive symptoms using the Depression Scale (DEPS).
- Patients were stratified into quartiles based on DEPS scores and followed for a median of 6.3 years for mortality outcomes.
- Statistical analyses, including univariate and multivariate risk assessments, were performed to evaluate the association between DEPS quartiles and different death types.
Main Results:
- The incidence of SCD increased progressively across DEPS quartiles, with the highest quartile showing a fourfold elevated univariate risk and a 3.2-fold elevated multivariate risk for SCD compared to the lowest quartile.
- Depressive symptoms were significantly associated with an increased risk of SCD, independent of established clinical risk factors.
- No significant association was found between DEPS scores and non-SCD or noncardiac deaths.
Conclusions:
- Depressive symptoms are a significant independent predictor of sudden cardiac death in patients with stable coronary artery disease.
- These findings underscore the importance of routine depression screening and the implementation of interventions to manage depressive symptoms in CAD patients to potentially reduce SCD risk.
Abstract:
The association between the mode of death and depression in patients with stable coronary artery disease (CAD) is far from clear. We investigated the association between depressive symptoms and the mode of death including all-cause mortality, noncardiac death, sudden cardiac death (SCD), and non-SCD in stable CAD patients. Patients with angiographically documented CAD (n = 1,928) underwent a clinical examination including screening for depression symptoms with the Depression Scale (DEPS) and extensive risk profiling at the baseline. The patients were divided into quartiles based on their DEPS score. The patients entered the follow-up (median 6.3 years) during which 49 SCDs (2.5%) and 48 non-SCDs (2.5%) occurred. The incidence of SCD was 1.1% (5 events), 2.0% (9 events), 2.6% (14 events), and 4.4% (21 events) from the lowest to the highest quartile of DEPS. The patients in the highest quartile of DEPS had a fourfold elevated univariate risk (95% confidence interval 1.5 to 10.5; p = 0.006), and after adjustment for traditional risk factors, a 3.2-fold elevated multivariate risk (95% confidence interval 1.2 to 8.9, p = 0.025) for SCD compared with patients in the lowest quartile. DEPS was not associated with non-SCD or noncardiac deaths. Depressive symptoms are associated with an increased risk of SCD independently of clinical risk factors in patients with CAD. The results highlight the importance of screening for depression and emphasize the need for additional interventions to alleviate the depressive symptoms in these patients.
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