Depression doubles risk for death following CAD diagnosis

WASHINGTON — In a study presented at the American College of Cardiology Scientific Session, depress was identified as the strongest predictor of death in the first decade after CAD diagnosis.

Perspective from Allan S. Jaffe, MD

Risk for death after MI and angina was doubled in patients with a depression diagnosis, Heidi T. May, PhD, cardiovascular epidemiologist at the Intermountain Medical Center Heart Institute in Salt Lake City, and colleagues reported.

“This study shows that it doesn’t matter if depression emerges in the short term or a few years down the road — it’s a risk factor that continually needs to be assessed,” May said in a press release. “I think the take-home message is that patients with coronary disease need to be continuously screened for depression and if found to be depressed, they need to receive adequate treatment and continued follow-up.”

May and colleagues analyzed 24,137 patients diagnosed with MI and stable or unstable angina who had angiographically determined CAD (stenosis > 70%).

Depression was determined using ICD codes and was evaluated as a time-varying covariate in multivariable Cox hazard regression models to control for time differences between CAD diagnosis and depression diagnosis.

During a mean follow-up of 9.7 years, 15% of patients were diagnosed with depression.

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Those diagnosed with depression were younger than those without depression (64 years vs. 65 years); were more likely to be female (37% vs. 24%), have diabetes (40% vs. 30%) and have a prior diagnosis of depression (26% vs. 5%); and were less likely to have prior MI (28% vs. 36%).

Forty percent of patients died during follow-up. The mortality rate was higher among patients with CAD and depression compared with CAD only (50% vs. 38%; P < .0001), according to the findings.

After adjustment for age, sex, MI or chest pain, medications and other risk factors, depression diagnosis after CAD was the strongest predictor of death (HR = 2; P < .001), May and colleagues reported.

The association between death and depression was present in patients with no prior history of depression (HR = 2; P < .0001) and was consistent across angiography findings: stable angina (HR = 1.84; P < .0001), unstable angina (HR = 2.25; P < .0001) and MI (HR = 2.09; P < .0001).

“It can be devastating to be diagnosed with CAD,” May said. “Clinicians need to pay attention to the things their patients are expressing, in terms of both physical symptoms as well as emotional nonverbal factors.” – by Dave Quaile

Reference:

May HT, et al. Abstract 1126-318. Presented at: American College of Cardiology Scientific Session; March 17-19, 2017; Washington, D.C.

Disclosure : Cardiology Today was unable to obtain relevant financial disclosures.

Perspective

Allan S. Jaffe, MD

The critical issue here is the diagnosis of depression. Depressive symptoms are common but could have multiple causes. Take insomnia as an example. It could be depression or some other psychological issue or a physical issue. Thus, often symptoms are assumed to be due to depression when they may not be. If so, any problem in a patient with heart disease could be assumed to be that and coded that way. Most of us prefer to use validated instruments to make the diagnosis of depression, and there are short easy ones like the BDI. I would be wary of the diagnosis in this study.

Allan S. Jaffe, MD

Cardiology Today Editorial Board member

Mayo Clinic

Disclosures: Jaffe reports consulting for Abbott, Alere, Beckman, NeurogenomeX, Novartis, Outpost Medical, Roche, Siemens, Sphingotec and theheart.org.