Depression After PCI Linked to Long-term Mortality
Patients who report being depressed 6 months after undergoing percutaneous coronary intervention (PCI) have a 50% increased risk of dying within 7 years, according to registry data presented March 16, 2012, at the 12th Annual Spring Meeting on Cardiovascular Nursing in Copenhagen, Denmark.
For the study, Nikki L. M. Damen, of Erasmus Medical Center (Rotterdam, The Netherlands), and colleagues looked at 1,234 consecutive patients from the RESEARCH (Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital) registry who completed the Hospital Anxiety and Depression Scale to assess depression 6 months after PCI. Follow-up was obtained for a median of 7 years.
The 6-month prevalence of depression was 26.2% (n = 324), and by 7 years, 15.2% of patients (n = 187) had died. All-cause mortality was greater in patients who reported depression compared with those who did not (23.5% vs. 12.2%; P < 0.001).
After adjustment for potential confounders, depression was associated with a higher risk of death at 7 years (HR 1.56; 95% CI 1.03-1.25; P = 0.035). Male sex, older age, and diabetes were also significantly associated with an increased risk, whereas statin use appeared to reduced risk.
The authors conclude that “[early] identification and treatment of depression is important to curb the adverse effects of depression on health outcome.” Further investigation is needed to “examine the impact of depression on long-term mortality, in addition to short-term mortality,” they add.
In an e-mail communication with TCTMD, co-author Susanne S. Pedersen, PhD, also of Erasmus Medical Center, said that while the reasons for the relationship between death and depression remain unknown, “one possible explanation is that depressed patients may have less healthy lifestyles with regard to smoking, drinking alcohol, physical activity, and diet, and [they] may be less likely to take their medications. Another possible explanation is that depression could alter the activity of the sympathetic nervous system, leading to increases in heart rate and blood pressure.”
Few studies have examined whether depression is an independent risk factor for poor prognosis in PCI patients, she said, adding that more work is needed before deciding whether this population could benefit from systematic mental health screening.
Dr. Pedersen pointed out that it is unclear whether depression itself heightens risk, or whether it is a marker for some other factor. Moreover, for depression to be “on par with established biomedical risk factors, we need to be able to demonstrate that if we influence depression then there will be an improvement in survival in these patients,” she noted.
Based on the mental health literature, Dr. Pedersen stressed, “The assumption that ‘one size fits all’ and that all patients will benefit from the same intervention . . . does not hold. Rather it seems that it might be important to figure patient preferences regarding type of treatment into the equation.”
Other unanswered questions include the optimal timing for intervention, since “chronic depression may be more dangerous and also more treatment-resistant,” Dr. Pedersen said, as well as how best to identify not only patients with clinical depression but those with minimal symptoms, since both carry risk. “The question is how we should deal with this issue in clinical practice,” she said.
Three-quarters of patients were men, and the average age was 62 years.
Damen NLM, Versteeg H, Boersma E, et al. Depression is independently associated with 7-year mortality in patients treated with percutaneous coronary intervention: Results from the research registry. Presented at: 12th Annual Spring Meeting on Cardiovascular Nursing; March 16, 2012; Copenhagen, Denmark.
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- Ms. Damen and Dr. Pedersen report no significant conflicts of interest.