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Depression linked to adverse outcomes in patients with stable angina
Depression appears to increase the risk for all-cause mortality and MI in patients with stable angina, according to new findings published in Circulation: Cardiovascular Quality and Outcomes.
Although depression is common among patients after MI, its relationship with stable angina is far less known, Natalie Szpakowski, MD, from the Schulich Heart Centre, division of cardiology, department of medicine, Sunnybrook Health Sciences Center, University of Toronto, and colleagues wrote, noting that depression affects nearly one in five patients with stable angina and has been associated with poor outcomes such as death and MI.
They retrospectively analyzed a cohort of 22,917 patients aged at least 20 years from Ontario, Canada, newly diagnosed with stable angina based on obstructive CAD found on angiogram, to determine predictors of developing depression.
Physician billing codes and hospital-admission diagnostic codes were used to ascertain depression in the cohort.
The primary outcome was all-cause mortality. Secondary outcomes included admission for MI and revascularization.
From the initial cohort, 12.7% of patients were excluded due to a recent diagnosis of depression. In the final cohort, however, 31.1% of patients had a diagnosis of depression.
In the final cohort, 18.8% of patients (n = 4,305) had a first occurrence of depression after angiogram (mean follow-up, 1,084 days; rate, 63.2 per 1,000 patient-years).
Compared with those who did not, patients who developed depression had a higher risk for all-cause mortality (HR = 1.83; 95% CI, 1.62-2.07) and admission for MI (HR = 1.36, 95% CI, 1.1-1.67), according to the researchers.
However, there was no significant difference by depression status for revascularization (HR = 1.13; 95% CI, 0.99-1.28).
“Unfortunately, depression is often recurrent in patients with [CAD] and, without treatment, is likely to persist,” the researchers wrote. “The possible benefits of treating depression provide an opportunity to reduce adverse CV outcomes and their associated costs in this population.” – by Dave Quaile
Disclosure: The researchers report no relevant financial disclosures.