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Depression May Be Independent Risk Factor For All-Cause Mortality After Acute Myocardial Infarction
A DGReview of :"Depression as a risk factor for mortality after acute myocardial infarction"
American Journal of Cardiology
12/17/2003
By Jill Taylor
Depression may increase the risk of all-cause mortality after acute myocardial infarction (AMI), according to a study based on a subsample of patients participating in the Enhancing Recovery In Coronary Heart Disease Patients (ENRICHD) clinical trial.
The ENRICHD trial, which was designed to determine whether treatment for depression and social isolation improves survival after AMI, failed to find a significant difference in survival between patients who received treatment for depression and those who did not.
A possible explanation for the ENRICHD trial result is that depression may no longer be a risk factor for mortality after AMI. To examine whether depression predicts all-cause mortality in the 30 months following AMI, Robert M. Carney, PhD, Behavioral Medicine Centre, St. Louis, Missouri, United States, and colleagues performed a study in which a subsample of the ENRICHD trial's depressed patients were compared with nondepressed patients.
The study population consisted of 358 depressed ENRICHD subjects and 408 nondepressed patients who met the ENRICHD medical inclusion criteria. Patients received follow-up assessment at 6 months after study enrolment, and annually thereafter for up to 30 months.
Results showed that during follow up, 7.4% experienced nonfatal AMIs and 6.1% died. Compared with nondepressed patients, patients with either major or minor depression were found to be at higher risk for all-cause mortality (hazard ratio 2.4, 95% confidence interval 1.2 to 4.7). However, after risk factor adjustment, depressed patients were not at higher risk for nonfatal AMI (hazard ratio 1.2, 95% confidence interval 0.7 to 2.0).
Interestingly, the effects of depression on mortality occurred late, at greater than 8 months post AMI.
"This study has the largest number of depressed patients and one of the longest follow-up periods of any prognostic study of depression in post-AMI patients conducted to date," say the researchers. "Continued research is needed to determine whether treating depression can reduce this risk, as well as improve quality of life after AMI."
Am J Cardiol 2003 Dec 1;92:11:1277-81.
"Depression as a risk factor for mortality after acute myocardial infarction"
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