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Clin Res Cardiol. 2014 May;103(5):389-95. doi: 10.1007/s00392-014-0666-6. Epub 2014 Jan 24.

Transient impact of baseline depression on mortality in patients with stable coronary heart disease during long-term follow-up.

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1
Klinik für Psychosomatische Medizin und Psychotherapie, Deutsches Zentrum für Herz- und Kreislaufforschung, Universität Göttingen, von-Siebold-Str. 5, 37075, Göttingen, Germany, thomas.meyer@med.uni-goettingen.de.

Abstract

OBJECTIVE:

The objective of this prospective study was to determine the impact of depressive symptoms on long-term survival in coronary heart disease (CHD) patients treated with intracoronary stenting.

METHODS:

Four hundred and seventy patients completed the Hospital Anxiety and Depression Scale (HADS) before undergoing stent implantation and were followed over a 5-year period. Survival data were collected from n = 462 participants (98.3 %). A cut-off ≥8 on the HADS depression subscale was used to indicate probable clinical levels of depression.

RESULTS:

All-cause mortality rates differed significantly between depressed and non-depressed patients at 2-year follow-up, as 6 out of 98 subjects with elevated HADS-D scores (6.1 %), but only 8 out of 364 (2.2 %) patients with normal HADS-D scores had died [odds ratio = 2.9, 95 % confidence interval (95 % CI) = 1.0-8.6, p = 0.044]. In a Cox regression model adjusted for sociodemographic and clinical parameters, positive HADS-D scores [hazard ratio (HR) = 4.3, 95 % CI = 1.2-15.4, p = 0.025], body-mass index (HR = 0.8, 95 % CI = 0.7-1.0, p = 0.040) and stent length (HR = 1.1, 95 % CI = 1.0-1.1, p = 0.042) independently predicted 2-year survival. From the third to the fifth year after index PCI, the frequency of deaths in the depressed patients' group did not significantly differ from that observed in non-depressed patients (5.5 % versus 7.0 %, p = 0.607), and the predictive role of baseline HADS-D scores for survival was lost.

CONCLUSION:

In CHD patients, self-rated depressive symptoms at baseline were negatively linked to survival at 2-year follow-up, but failed to predict mortality 3 years later. Thus, in contrast to other well-established risk factors, the prognostic value of depression for predicting adverse outcome may be temporarily limited. The mechanisms behind this transient effect need further study.

PMID:
24464107
DOI:
10.1007/s00392-014-0666-6
[Indexed for MEDLINE]
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