Depression predicts mortality and hospitalization in patients with myocardial infarction complicated by heart failure

Depression Predicts Cardiac Cachexia in Heart Failure Patients

BACKGROUND

Cardiac cachexia (CC) is associated with increased morbidity and mortality in persons with heart failure (HF). Compared to the biological underpinning of CC, little is known about the psychological factors. Thus, the overarching objective of this study was to determine whether depression predicts the onset of cachexia at 6 months in patients with chronic HF.

METHODS

114 participants with a mean age of 56.7 ± 13.0 years, LVEF of 33.13 ± 12.30% and NYHA class III (48.0%) were assessed for depression using the PHQ-9. Body weight was measured at baseline and at 6 months. Patients who had ≥6% non-edematous unintentional weight loss were classified as cachectic. Univariate and logistic multivariate regression were used to examine the relationship between CC and depression, controlling for clinical and demographic variables.

RESULTS

Cachectic patients (11.4%) had significantly higher baseline BMI levels (31.35 ± 5.70 vs. 28.31 ± 4.73; p = .038), lower LVEF (mean = 24.50 ± 9.48 vs. 34.22 ± 12.18, p = .009), and depression scores (mean = 7.17 ± 6.44 vs. 4.27 ± 3.98, p = .049) when compared to their non-cachectic counterparts. In multivariate regression analysis, depression scores (β = 1.193, p = .035) and LVEF (β = .835, p = .031) predicted cachexia after controlling for age, gender, body mass index, VO2 max, and New York Heart Association class and accounted for 49% of the variance in Cardiac cachexia. When depression was dichotomized, depression and LVEF predicted 52.6% of the variance in CC.

CONCLUSION

Depression predicts CC in patients with HF. Additional studies are needed to expand the knowledge of the role of the psychological determinants of this devastating syndrome.

Antidepressant’s long-term effect on cognitive performance and cardiovascular system

Background: The nature of antidepressants and their adverse effects should be considered when treating severe depression in individuals with psychotic symptoms. Antidepressant prescription rates have risen steadily over the last 30 years, affecting people of all ages. Aim: The goal of this study was to see if depression and antidepressant usage were linked to long-term changes in cognitive function and cardiovascular health. Methodology: Meta-analysis was performed using PRISMA guidelines along with using the SPIDER search framework using related keywords on different search engines i.e. Google scholars, PubMed, Scopus, ISI, etc. Total (n=2256) papers were obtained and assessed for eligibility. Altogether 15 studies were included using databases and other methods. The Newcastle-Ottawa Scale examined the grades provided by the data after numerous screenings. Result: A distinct link was found between antidepressants with cognitive performance and the cardiovascular system. Dementia and hypertension were prevailing long-term effects caused by frequent use of antidepressants in chronic and mild depression.

Depression: a predictor of coronary heart disease in Saudi Arabia

Aims and Objectives: This research study mainly deals to evaluate the effect of depression in coronary heart disease patients. Background: Depression is one of the common comorbidity among patients presented with acute coronary syndrome or those with major cardiovascular event. Depression has been independently associated or lead to acute cardiac events in patients. Method: The study was conducted from three months followed-up patients with recent diagnosed coronary heart disease and they getting treatment from cardiac centres “Armed Forces Hospitals. Depression was evaluated by using 17-item Hamilton Rating Scale and the cardiac outcome was assessed clinically by echo parameters and cardiac biomarkers such as C-reactive Protein. The data were analysis by SPSS version 23. Results: In this study 83 patients were part of this research. The patients had been picked up from range 18-65 year in which mostly patients were male (75%) than female (25%). Among 83 coronary heart disease patients 29.5% were suffering from depression while 19.5% were on severity. The deterioration factor was significantly influence by depression and smoking. Conclusion: Depression has a great impact on deterioration of the cardiac outcomes. It can serve as a predictive variable for future cardiological morbidity and mortality.

A study of abnormal cannabidiols system-mediated cardiovascular protection in disrupted gut/brain axis associated depression

Uncontrolled stress can lead to vascular injury, hypertension, arrhythmia, compromised immune system alteration in microbiota activity, and neurobehavioral changes, including depression. The gut microbiota has been recently developed, not only for major depressive disorders but also cardiovascular problems, as a therapeutic concern. Since then, >100 studies have studied the link between depression and cardiovascular disease (CVD), and have shown that depression is common (≈20%-35%) in patients with CVD, and seems to be indicative of negative heart effects in patients. Depressive symptoms patients have demonstrated an elevated platelet reactivity, reduced cardiac variability, and enhanced proinflammatory signals, which are all cardiovascular-related risk factors. The pathophysiology of depression-related CVD is nevertheless a challenge because of the heterogeneous depressive syndromes and the etiologies. The cardiovascular effects of tetrahydrocannabinol (THC) (the key psychotropic credential of cannabis) and endocannabinoids (THC endogenous equivalents which cause type 1 [CB1] and 2 [CB2] cannabinoids) have been extensively examined based on well-documented effects of marijuana smoke on blood pressure (BP) and heart rate (HR). Therefore, the aim of the review article is to establish the relationship of abnormal cannabidiols system-mediated cardiovascular protection in disrupted gut/brain axis associated depression to determine the translational potential of targeting abnormal cannabidiols receptors in clinical studies.

Psychological Disorders in Heart Failure

The occurrence of depression, anxiety, and insomnia is strikingly high in patients with heart failure and is linked to increased morbidity and mortality. However, symptoms are frequently unrecognized and the integration of mental health into cardiology care plans is not routine. This article describes the prevalence, identification, and treatment of common comorbid psychological disorders.

Depression but not frailty contributed to a higher risk for all-cause hospitalizations in male older veterans

INTRODUCTION

Frailty is a state of vulnerability to stressors resulting in higher morbidity, mortality, and utilization in older adults. Depression and frailty often coexist, suggesting a bidirectional relationship that may increase the effects of each individual condition on clinical outcomes and health-care utilization in older adults.

OBJECTIVE

To determine the effects of concurrent frailty and depression on all-cause hospitalizations.

METHODS/DESIGN

Prospective cohort study, conducted at a Veterans Affairs (VA) Medical Center. The participants were male, community-dwelling veterans 65 years and older. From 4 January through 30 December 2016, a 46-item frailty index was generated from data obtained from the VA electronic health record. Trained staff conducted in-depth reviews of electronic health records ascertaining depression status. Patients were followed through 31 December 2017 for all-cause hospitalizations following the initial assessment of frailty. After adjusting for covariates, the association of frailty and depression with all-cause hospitalizations was determined with the Andersen-Gill model, accounting for repeated hospitalizations.

RESULTS

Five hundred fifty-three male patients were part of the study, mean age 76.3 (SD = 8.2) years. One hundred eighty-one patients (32.7%) had depression diagnoses. During a median follow-up period of 530 days (interquartile range [IQR] = 245), 123 patients (22.2%) had 240 hospitalizations. Frailty status was not associated with future hospitalizations (adjusted hazard ratio [HR] = 1.61; 95% CI, 95-2.74; P > .05). Depression was associated with higher all-cause hospitalizations (adjusted HR = 1.57; 95% CI, 1.09-2.26); P = .0157).

CONCLUSIONS

Depression but not frailty was significantly associated with higher rates of all-cause hospitalization. Implementing interventions that target older adults with both frailty and depression may reduce the burden of both conditions and reduce hospitalizations.

HEART FAILURE, DEPRESSION AND EXERCISE

Introduction: Patients with heart failure have high rates of physical disability, based on self-reported difficulty in performing daily living activities. Depression is also a disease entity that has a high co-morbidity in combination with heart failure. Beyond the usual medical care of heart failure, there is a plethora of research on the contribution of exercise to cardiovascular parameters and to the muscular system of patients with heart failure, its effect on their quality of life and relief of depression symptoms. Purpose: The purpose of this study is to highlight the positive effect of exercise on patients with heart failure experiencing depression. Methodology: The study material consisted of articles on the topic, found in Greek and international databases such as: Google Scholar, Mednet, Pubmed, Medline and the Hellenic Academic Libraries Association (HEAL-Link), using the appropriate keywords: heart failure, depression, exercise programs. Results: Depression affects the clinical course and prognosis of patients with heart failure. The coexistence of depression and chronic heart failure leads to an increase in mortality. The benefits of exercise, therefore, in patients with heart failure and depression have a positive impact on the patients' quality of life by contributing to increasing their functional status, reducing their re-admissions to the hospital and relieving the symptoms of depression. Conclusions: The high incidence of depression in patients with chronic heart failure requires measures to prevent it, such as exercise. Health professionals need to help patients understand their condition and follow therapeutic guidelines, as well as therapeutic exercise, which can improve their lifestyle and behavior, and help them prevent depression symptoms and promote their quality of life.

Tackling Patient-Reported Outcomes in Atrial Fibrillation and Heart Failure: Identifying Disease-Specific Symptoms?

Atrial fibrillation (AF) and heart failure (HF) both significantly affect morbidity and mortality and also account for high symptom burden and impaired health-related quality of life (hrQoL). Several well-designed and broadly implemented patient-reported outcome instruments are available for both AF and HF and can easily measure hrQoL in each disease process. A better understanding of the diverse phenotypes of AF and HF, as well as the heterogeneous treatment effects of disease-specific interventions, is necessary to further disentangle the complex relationship between symptoms of AF and HF.

Trajectories of cognitive-affective depressive symptoms in acutely hospitalized older adults: The hospital-ADL study

OBJECTIVE

To identify trajectories of cognitive-affective depressive symptoms among acutely hospitalized older patients and whether trajectories are related to prognostic baseline factors and three-month outcomes such as functional decline, falls, unplanned readmissions, and mortality.

METHODS

Prospective multicenter cohort of acutely hospitalized patients aged ≥ 70. Depressive trajectories were based on Group Based Trajectory Modeling, using the Geriatric Depression Scale-15. Outcomes were functional decline, falls, unplanned readmission, and mortality within three months post-discharge.

RESULTS

The analytic sample included 398 patients (mean age = 79.6 years; SD = 6.6). Three distinct depressive symptoms trajectories were identified: minimal (63.6%), mild persistent (25.4%), and severe persistent (11.0%). Unadjusted results showed that, compared to the minimal symptoms group, the mild and severe persistent groups showed a significantly higher risk of functional decline (mild: OR = 3.9, p < .001; severe: OR = 3.0, p = .04), falls (mild: OR = 2.0, p = .02; severe: OR = 6.0, p < .001), and mortality (mild: OR = 2.2, p = .05; severe: OR = 3.4, p = .009). Patients with mild or severe persistent symptoms were more malnourished, anxious, and functionally limited and had more medical comorbidities at admission.

CONCLUSION

Nearly 40% of the acutely hospitalized older adults exhibited mild to severe levels of cognitive-affective depressive symptoms. In light of the substantially elevated risk of serious complications and the fact that elevated depressive symptoms was not a transient phenomenon identification of these patients is needed. This further emphasizes the need for acute care hospitals, as a point of engagement with older adults, to develop discharge or screening procedures for managing cognitive-affective depressive symptoms.

Depression Effects on Hospital Cost of Heart Failure Patients in California: An Analysis by Ethnicity and Gender

Background

Depression often interferes with self-management and treatment of medical conditions. This may result in serious medical complications and escalated health-care cost.

Objectives

Study distribution of heart failure (HF) cases estimates the prevalence of depression and its effects on HF-related hospital costs by ethnicity and gender.

Methods

Secondary data files of California Hospital Discharge System for he year 2010 were examined. For patients with a HF diagnosis, details regarding depression, demographics, comorbid conditions, and hospital costs were studied. Age-adjusted HF rates and depression were examined for whites, blacks, Hispanics, and Asians/Pacific Islanders (AP) by comparing HF patients with depression (HF^+D) versus HF without depression (HF^ND).

Results

HF cases (n = 62,685; average age: 73) included nearly an equal number of males and females. HF rates were higher (P < 0.001) among blacks compared to Hispanics, AP, and whites and higher among males than females. One-fifth of HF patients had depression, higher among females and whites compared to males and other ethnic groups. Further, HF hospital costs for blacks and AP were higher (P < 0.001) compared to other groups. The cost for HF^+D was 22% higher compared to HF^ND, across all gender and ethnic groups, largely due to higher comorbidities, more admissions, and longer hospitalization.

Conclusion

Depression, ethnicity, and gender are all associated with increased hospital costs of HF patients. The higher HF and HF^+D costs among blacks, AP, and males reflect additional burden of comorbidities (hypertension and diabetes). Prospective studies to assess if selective screening and treating depression among HF patients can reduce hospital costs are warranted.

Polygenic loading for major depression is associated with specific medical comorbidity

Major depressive disorder frequently co-occurs with medical disorders, raising the possibility of shared genetic liability. Recent identification of 15 novel genetic loci associated with depression allows direct investigation of this question. In cohorts of individuals participating in biobanks at two academic medical centers, we calculated polygenic loading for risk loci reported to be associated with depression. We then examined the association between such loading and 50 groups of clinical diagnoses, or topics, drawn from these patients' electronic health records, determined using a novel application of latent Dirichilet allocation. Three topics showed experiment-wide association with the depression liability score; these included diagnostic groups representing greater prevalence of mood and anxiety disorders, greater prevalence of cardiac ischemia, and a decreased prevalence of heart failure. The latter two associations persisted even among individuals with no mood disorder diagnosis. This application of a novel method for grouping related diagnoses in biobanks indicate shared genetic risk for depression and cardiac disease, with a pattern suggesting greater ischemic risk and diminished heart failure risk.

Exposure to Work and Nonwork Stressors and the Development of Heart Disease Among Canadian Workers Aged 40 Years and Older: A 16-year Follow-up Study (1994 to 2010)

OBJECTIVE

The aim of this study was to evaluate the contribution of work, nonwork, and individual factors to self-reported heart disease, and to evaluate gender-related differences over a period of 16 years among Canadian workers aged 40 years and more.

METHODS

Using the National Population Health Survey (NPHS, 1994 to 2010), we estimated multilevel logistic regression models (N = 2996).

RESULTS

Couple-related strains, being a man, age, hypertension, and body mass index, are associated with an increased risk of heart disease. In analysis stratified by gender, physical demands at work and having high child-related strains were associated with heart disease specifically among women. Psychotropic drug use increased the risk of heart disease only in men.

CONCLUSION

Our study suggests that work stressors measured by Statistics Canada NPHS are largely not associated with the risk of heart disease, except in women exposed to physical demands at work.

Major Depression and Long-Term Survival of Patients With Heart Failure

OBJECTIVES

Previous studies have found that depression predicts all-cause mortality in heart failure (HF), but little is known about its effect on long-term survival. This study examined the effects of depression on long-term survival in patients with HF.

METHODS

Patients hospitalized with HF (n = 662) at an urban academic medical center were enrolled in a prospective cohort study between January 1994 and July 1999. Depression was assessed on a structured interview during the index hospitalization and on quarterly interviews for 1 year after discharge. Patients were classified at index as having Diagnostic and Statistical Manual, Fourth Edition major depressive disorder (n = 131), minor depression (n = 106), or no depression (n = 425). Clinical data and the National Death Index were used to identify date of death or last known contact through December 19, 2014, up to 20 years after the index hospitalization. The main outcome was time from enrollment to death from any cause.

RESULTS

A total of 617 (94.1%) patients died during the follow-up period. Major depressive disorder was associated with higher all-cause mortality compared with no depression (adjusted hazard ratio = 1.64, 95% confidence interval = 1.27-2.11, p = .0001). This association was stronger than that of any of the established predictors of mortality that were included in the fully adjusted model. Patients with persistent or worsening depressive symptoms during the year after discharge were at greatest risk for death. The association between minor depression and survival was not significant.

CONCLUSIONS

Major depression is an independent risk factor for all-cause mortality in patients with HF. Its effect persists for many years after the diagnosis of depression.

Depression predicts mortality and hospitalization in heart failure: A six-years follow-up study

BACKGROUND

The aim of this study is to evaluate the prevalence of depressive symptoms (DS) and its relation on hospitalization for cardiovascular (CV) causes and all-cause mortality risk among outpatients with HF.

METHODS

A prospective study was conducted on 130 adult outpatients with HF. The Beck Depression Inventory Scale-second edition (BDI-II) was used to screen for DS. All-cause mortality and hospitalization for CV causes were registered over 6 years. Logistic regression and multinomial logistic regression analysis were used to evaluate the independent prognostic value of DS on mortality and hospitalization for CV causes after adjustment for clinical risk factors.

RESULTS

During a mean follow-up of 6 years, 44% of patients were classified as having DS. Sixty-two participants died for all causes, representing 61% of those with DS and 37% of those without (p=0.006); Forty-nine participants (38%) were hospitalized for CV causes, representing 49% of those with DS and 29% of those without (p=0.027). Logistic regression analysis indicated that DS predicted all-cause mortality (OR: 2.905; 95% CI:1.228-6.870; p=0.006) and multinomial logistic regression indicated that DS were predictive of hospitalization for CV causes (OR: 3.169; 95% CI: 1.230-8.164; p=0.027). These associations were independent of conventional risk factors.

LIMITATIONS

Only outpatient sample; measure of DS only at baseline; cause of death was not known.

CONCLUSION

This study, first held in a portuguese population, showed that DS are independent predictors of death and hospitalization for CV causes among HF patients and its impact persists over 6 years.

Cognitive Dysfunction, Medication Management, and the Risk of Readmission in Hospital Inpatients

OBJECTIVES

To determine whether cognitive dysfunction, in particular impaired executive function, may be a risk factor for early readmission in older adults independently managing their medications.

DESIGN

Prospective observational study.

SETTING

Tertiary hospital.

PARTICIPANTS

Individuals aged 65 years and older discharged to home from the medicine service of a tertiary hospital (N = 452).

MEASUREMENTS

Participants underwent a cognitive assessment including the Short Blessed Test (SBT), the executive function component of the Montreal Cognitive Assessment, and the Trail-Making Test Part B (TMT-B). Hospital use and demographic data were obtained. A logistic regression model was used to fit the likelihood of readmission on the basis of participant characteristics, medication management, and cognitive performance. Likelihood of hospital readmission within 30 days was determined.

RESULTS

For participants managing medications themselves, adjusted 30-day odds of readmission increased 13% on average with each point decrease in SBT score (P = .003) and 9% on average with each 0.01 decrease in TMT-B score (P = .02). For participants who were independent in medication management with more than seven medications, the odds of 30-day readmission increased 16% on average with each point decrease in SBT score (P = .01) and 15% on average with each 0.01 decrease in TMT-B score (P = .03).

CONCLUSION

Cognitive dysfunction, particularly executive dysfunction, is a risk factor for readmission in individuals managing their own medications. This risk is greater in individuals taking more than seven medications. The interaction of cognitive function, medication management, and number of medications may enhance risk-stratification efforts to identify individuals at risk of early readmission.

Depressive symptoms are associated with higher rates of readmission or mortality after medical hospitalization: A systematic review and meta-analysis

Depressive symptoms during a medical hospitalization may be an overlooked prognostic factor for adverse events postdischarge. Our aim was to evaluate whether depressive symptoms predict 30-day readmission or death after medical hospitalization. We conducted a systematic review of studies that compared postdischarge outcomes by in-hospital depressive status. We assessed study quality and pooled published and unpublished data using random effects models. Overall, one-third of 6104 patients discharged from medical wards were depressed (interquartile range, 27%-40%). Compared to inpatients without depression, those discharged with depressive symptoms were more likely to be readmitted (20.4% vs 13.7%, risk ratio [RR]: 1.73, 95% confidence interval [CI]: 1.16-2.58) or die (2.8% vs 1.5%, RR: 2.13, 95% CI: 1.31-3.44) within 30 days. Depressive symptoms were common in medical inpatients and are associated with an increased risk of adverse events postdischarge. Journal of Hospital Medicine 2016;11:373-380. © 2016 The Authors Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital Medicine.

Current depressive symptoms but not history of depression predict hospital readmission or death after discharge from medical wards: a multisite prospective cohort study

OBJECTIVE

Although death or readmission shortly after hospital discharge is frequent, identifying inpatients at higher risk is difficult. We evaluated whether in-hospital depressive symptoms (hereafter "depression") are associated with short-term readmission or mortality after discharge from medical wards.

METHODS

Depression was assessed at discharge in a prospective inpatient cohort from 2 Canadian hospitals (7 medical wards) and defined as scores ≥ 11 on the 27-point Patient Health Questionnaire (PHQ-9). Primary outcome was all-cause readmission or mortality 90 days postdischarge.

RESULTS

Of 495 medical patients [median age 64 years, 51% women, top 3 admitting diagnoses heart failure (10%), pneumonia (10%) and chronic obstructive pulmonary disease (8%)], 127 (26%) screened positive for depression at discharge. Compared with nondepressed patients, those with depression were more frequently readmitted or died: 27/127 (21%) vs. 58/368 (16%) within 30 days and 46 (36%) vs. 91 (25%) within 90 days [adjusted odds ratio (aOR) 2.00, 95% confidence interval 1.25-3.17, P=.004, adjusted for age, sex and readmission/death prediction scores]. History of depression did not predict 90-day events (aOR 1.05, 95% CI 0.64-1.72, P=.84). Depression persisted in 40% of patients at 30 days and 17% at 90 days.

CONCLUSIONS

Depression was common, underrecognized and often persisted postdischarge. Current symptoms of depression, but not history, identified greater risk of short-term events independent of current risk prediction rules.

Are andropause symptoms related to depression?

BACKGROUND

Andropause is a middle-age condition in which men experience changes in their physical, spiritual and emotional health. The association between andropause and psychological symptoms such as depression are not very clear yet.

AIMS

The objective of this study was therefore to determine the association between the 'Aging Males Symptoms Scale' (AMS) and depression.

METHODS

A cross sectional study was conducted among 521 old men. To collect data, the AMS and the Patient Health Questionnaires 2 and 9 were used to screen depression, in addition to questions on background and fertility. Multiple linear regression analysis was used to assess the association between andropause symptoms and depression.

RESULTS

Based on our results and the AMS score, 51.5% of the study population had clinical symptoms of androgen disorder, 3.7% of which had severe symptoms. There was a strong correlation between the AMS score and depression. Depression, diabetes, cigarette smoking and spousal age retained their significant associations even after entering the relevant demographic, anthropometric, smoking and disease variables in the multivariable model. As a positive predictive factor, depression had the strongest association with AMS.

CONCLUSIONS

Based on our results, there is a direct association between andropause symptoms and depression, where the increasing AMS score corresponds with the severity of depression.

DISCUSSION

Our results show the need of screening for depression when evaluating andropause symptoms.

Prolonged grief symptoms related to loss of physical functioning: examining unique associations with medical service utilization

PURPOSE

Prolonged grief, a severe and chronic form of grieving most commonly studied in the context of bereavement, may have relevance to losses associated with chronic illness (e.g. grief related to loss of functioning or loss of a planned future). The purpose of the present study is to examine the unique associations between prolonged grief symptoms and service utilization patterns.

METHODS

An online self-report assessment battery was administered among a sample of 275 older adults with at least one chronic illness that caused significant physical impairment.

RESULTS

Even after statistically controlling for relevant physical health (e.g. severity of physical limitations, somatic symptoms, number of chronic illnesses) and psychosocial variables (e.g. social support, depression/anxiety), more severe prolonged grief symptoms were associated with a greater number of emergency room visits, overnight stays in the hospital and total nights in the hospital.

CONCLUSIONS

These findings highlight the importance of screening for prolonged grief symptomatology with older individuals with a debilitating chronic illness.

IMPLICATIONS FOR REHABILITATION

Recent evidence suggests that prolonged grief may have relevance for losses associated with physical illness. The present study shows that prolonged grief reactions related to physical illness (e.g. grieving the loss of functioning) are uniquely associated with increased hospital-based service utilization. Given the relevance of prolonged grief reactions in this population, practitioners may wish to assess for these symptoms. Future clinical research should focus on developing interventions to target prolonged grief symptoms associated with these losses.

The bidirectional relationship between myocardial infarction and depressive disorders: a follow-up study

BACKGROUND

Data from multiple studies have shown the relationship between myocardial infarction (MI) and depressive disorders; however, most of these studies have focused only on one direction in evaluating the effect of depressive disorders on MI outcomes. This study analyzed data compiled from a large-scale dataset, the National Health Insurance Research Database, to determine whether a bidirectional relationship exists between MI and depressive disorders.

METHODS

A total of 3482 patients diagnosed with MI between 2002 and 2004 were included in analyzing the effects of MI on depressive disorders. A total of 26,418 patients diagnosed with depressive disorders between 2002 and 2004 were included in studying the effect of depressive disorders on MI. The comparison groups of both analyses were 4-fold larger than the case group. The Cox proportional hazard regression model was used to analyze the results.

RESULTS

The risk of MI patients developing depressive disorders was significantly higher (P<.001) than that of the comparison group, even after the data were adjusted for the variables of age, gender, income, region, and the Charlson Comorbidity Index. Conversely, the risk of patients with depressive disorders developing MI was not significantly higher than that of the comparison group after we controlled for covariates.

CONCLUSION

The patients with MI exhibited a significantly higher risk of developing depressive disorders compared with the patients without MI. The results suggest that health providers should carefully manage the treatment offered for mental conditions and sensitively detect the psychological reactions of patients with MI.

Depression after heart failure and risk of cardiovascular and all-cause mortality: a meta-analysis

OBJECTIVES

The aim of this study is to investigate whether depression after heart failure (HF) was a predictor for subsequent cardiovascular and all-cause mortality in prospective observational studies.

METHODS

Pubmed, Embase, and PsycInfo databases were searched for prospective studies reported depression after HF and subsequent risk of cardiovascular or all-cause mortality (prior to May 2013). Pooled adjust hazard ratio (HR) and corresponding 95% confidence intervals (CI) were calculated separately for categorical risk estimates.

RESULTS

Nine studies with 4012 HF patients were identified and analyzed. Pooled HR of all-cause mortality was 1.51 (95% CI 1.19-1.91) for depression compared with non-depressive patients. Subgroup analyses showed that major depression significantly increased all-cause mortality (HR=1.98, 95% CI 1.23-3.19), but not mild depression (HR=1.04, 95% CI 0.75-1.45). Pooled HR of cardiovascular mortality was 2.19 (95% CI 1.46-3.29) for depression compared with non-depressive patients.

CONCLUSION

Major depression after HF was a predictor for subsequent all-cause mortality, but not mild depression. More well-designed studies are needed to explore the influence of depression and antidepressant medication use on cardiovascular and all-cause mortality in HF patients.

Depressive symptoms and cardiovascular burden-related mortality among the aged

BACKGROUND

Depressive symptoms have been linked to increased cardiovascular mortality among the elderly. This study was aimed to test the independent and additive predictive value of depressive symptoms and B-type natriuretic peptide (BNP), a marker of direct cardiovascular stress and a strong predictor of mortality, together with traditional cardiovascular risk markers on total and cardiovascular mortalities in a general elderly population.

METHODS

A total of 508 subjects aged 75 or older participated in the study. The prognostic capacity of depressive symptoms and BNP in regard to total and cardiovascular mortalities was assessed with Cox regression analyses. Depressive symptoms were handled as a dichotomous variable based on the Zung self-rated depression scale score with a cut-off point of 40.

RESULTS

The median follow-up time was 84 months with an interquartile range of 36-99 months. Depressive symptoms reflected susceptibility to all-cause (HR 1·60; 95% CI 1·26-2·04) and cardiovascular mortalities (HR 1·81; 95% CI 1·30-2·52) only in univariable analyses. When cardiovascular illnesses and risk markers were taken into account, depressive symptoms lost their significance as an independent predictor of mortality. BNP as a continuous variable was a significant predictor of both all-cause (HR 1·44; 95% CI 1·22-1·69) and cardiovascular mortalities (HR 1·79; 95% CI 1·44-2·22) in fully adjusted models including depressive symptoms as a covariate.

CONCLUSIONS

The prognostic capacity of depressive symptoms is closely linked to cardiovascular morbidity and has no independent power in an elderly general population. BNP remains a strong harbinger of death regardless of depressive symptoms status.

Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association

BACKGROUND

Although prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome.

METHODS AND RESULTS

Writing group members were approved by the American Heart Association's Scientific Statement and Manuscript Oversight Committees. A systematic literature review on depression and adverse medical outcomes after acute coronary syndrome was conducted that included all-cause mortality, cardiac mortality, and composite outcomes for mortality and nonfatal events. The review assessed the strength, consistency, independence, and generalizability of the published studies. A total of 53 individual studies (32 reported on associations with all-cause mortality, 12 on cardiac mortality, and 22 on composite outcomes) and 4 meta-analyses met inclusion criteria. There was heterogeneity across studies in terms of the demographic composition of study samples, definition and measurement of depression, length of follow-up, and covariates included in the multivariable models. Despite limitations in some individual studies, our review identified generally consistent associations between depression and adverse outcomes.

CONCLUSIONS

Despite the heterogeneity of published studies included in this review, the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome.

Depressive symptoms and hospital readmission in older adults

OBJECTIVES

To quantify the risk of 30-day unplanned hospital readmission in adults aged 65 and older with depressive symptoms.

DESIGN

Prospective cohort study.

SETTING

University of Maryland Medical Center.

PARTICIPANTS

Individuals aged 65 and older admitted between July 1, 2011, and August 9, 2012, to the general medical and surgical units and followed for 31 days after hospital discharge (N = 750).

MEASUREMENTS

Primary exposure was depressive symptoms at admission, defined as a score of 6 or more on the 15-item Geriatric Depression Scale. Primary outcome was unplanned 30-day hospital readmission, defined as an unscheduled overnight stay at any inpatient facility not occurring in the emergency department.

RESULTS

Prevalence of depressive symptoms was 19% and incidence of 30-day unplanned hospital readmission was 19%. Depressive symptoms were not significantly associated with hospital readmission (relative risk (RR) = 1.20, 95% confidence interval (CI) = 0.83-1.72). Age, Charlson Comorbidity Index score, and number of hospitalizations within the past 6 months were significant predictors of unplanned 30-day hospital readmission.

CONCLUSION

Although not associated with hospital readmission, depressive symptoms were associated with other poor outcomes and may be underdiagnosed in hospitalized older adults. Hospitals interested in reducing readmission should focus on older adults with more comorbid illness and recent hospitalizations.

Pretreatment cortisol levels predict posttreatment outcomes among older adults with depression in cognitive behavioral therapy

Previous studies suggest that individuals with elevated levels of cortisol (the "stress hormone") could be particularly resistant to treatment for depression. However, most of these studies have been conducted in the context of antidepressant medications, and no study has examined pretreatment cortisol levels as a predictor of treatment outcomes among older adults with depression in cognitive-behavioral therapy (CBT), despite the relevance of this population for such a research question. The current study includes 54 older adults with depression who provided salivary cortisol samples at baseline and completed measures of depression at pretreatment and posttreatment, following a 12-week course of CBT. Structural equation modeling results suggest that those with higher daily outputs of cortisol and flatter diurnal slopes were less likely to benefit from CBT-a finding which if replicated could have important implications for clinical practice and future research.

Cataract, visual impairment and long-term mortality in a rural cohort in India: the Andhra Pradesh Eye Disease Study

BACKGROUND

A large-scale prevalence survey of blindness and visual impairment (The Andhra Pradesh Eye Diseases Study [APEDS1]) was conducted between 1996-2000 on 10,293 individuals of all ages in three rural and one urban clusters in Andhra Pradesh, Southern India. More than a decade later (June 2009-March 2010), APEDS1 participants in rural clusters were traced (termed APEDS2) to determine ocular risk factors for mortality in this longitudinal cohort.

METHODS AND FINDINGS

Mortality hazard ratio (HR) analysis was performed for those aged >30 years at APEDS1, using Cox proportional hazard regression models to identify associations between ocular exposures and risk of mortality. Blindness and visual impairment (VI) were defined using Indian definitions. 799/4,188 (19.1%) participants had died and 308 (7.3%) had migrated. Mortality was higher in males than females (p<0.001). In multivariable analysis, after adjusting for age, gender, diabetes, hypertension, body mass index, smoking and education status the mortality HR was 1.9 (95% CI: 1.5-2.5) for blindness; 1.4 (95% CI: 1.2-1.7) for VI; 1.8 (95% CI: 1.4-2.3) for pure nuclear cataract, 1.5 (95% CI: 1.1-2.1) for pure cortical cataract; 1.96 (95% CI: 1.6-2.4) for mixed cataract, 2.0 (95% CI: 1.4-2.9) for history of cataract surgery, and 1.58 (95% CI: 1.3-1.9) for any cataract. When all these factors were included in the model, the HRs were attenuated, being 1.5 (95% CI: 1.1-2.0) for blindness and 1.2 (95% CI: 0.9-1.5) for VI. For lens type, the HRs were as follows: pure nuclear cataract, 1.6 (95% CI: 1.3-2.1); pure cortical cataract, 1.5 (95% CI: 1.1-2.1); mixed cataract, 1.8 (95% CI: 1.4-2.2), and history of previous cataract surgery, 1.8 (95% CI: 1.3-2.6).

CONCLUSIONS

All types of cataract, history of cataract surgery and VI had an increased risk of mortality that further suggests that these could be potential markers of ageing.

Depressive symptoms and risk of new cardiovascular events or death in patients with myocardial infarction: a population-based longitudinal study examining health behaviors and health care interventions

BACKGROUND

Depressive symptoms is associated with adverse cardiovascular outcomes in patients with myocardial infarction (MI), but the underlying mechanisms are unclear and it remains unknown whether subgroups of patients are at a particularly high relative risk of adverse outcomes. We examined the risk of new cardiovascular events and/or death in patients with depressive symptoms following first-time MI taking into account other secondary preventive factors. We further explored whether we could identify subgroups of patients with a particularly high relative risk of adverse outcomes.

METHODS AND RESULTS

We conducted a prospective population-based cohort study of 897 patients discharged with first-time MI between 1 January 2009 and 31 December 2009, and followed up until 31 July 2012. Depressive symptoms were found in 18.6% using the Hospital Anxiety and Depression Scale (HADS-D≥8). A total of 239 new cardiovascular events, 95 deaths, and 288 composite events (239 new cardiovascular events and 49 deaths) occurred during 1,975 person-years of follow-up. Event-free survival was evaluated using Cox regression analysis. Compared to the 730 patients without depressive symptoms (HADS-D<8), the 167 patients with depressive symptoms (HADS-D≥8) had age- and sex-adjusted hazard ratios [HR] (95% confidence interval [CI]) of 1.53 (95% CI, 1.14-2.05) for a new cardiovascular event, 3.10 (95% CI, 2.04-4.71) for death and 1.77 (95% CI, 1.36-2.31) for a composite event. The associations were attenuated when adjusted for disease severity, comorbid conditions and physical inactivity; HR = 1.17 (95% CI, 0.85-1.61) for a new cardiovascular event, HR = 2.01 (95% CI, 1.28-3.16) for death, and HR = 1.33 (95% CI, 1.00-1.76) for a composite event. No subgroups of patients had a particularly high risk of adverse outcomes.

CONCLUSIONS

Depressive symptoms following first-time MI was an independent prognostic risk factor for death, but not for new cardiovascular events. We found no subgroups of patients with a particularly high relative risk of adverse outcomes.

Can the care transitions measure predict rehospitalization risk or home health nursing use of home healthcare patients?

The Care Transitions Measure (CTM) was designed to assess the quality of patient transitions from the hospital. Many hospitals are using the measure to inform their efforts to improve transitional care. We sought to determine if the measure would have utility for home healthcare providers by predicting newly admitted patients at heightened risk for emergency department use, rehospitalization, or increased home health nursing visits. The CTM was administered to 495 home healthcare patients shortly after hospital discharge and home healthcare admission. Follow-up interviews were completed 30 and 60 days post hospital discharge. Interview data were supplemented with agency assessment and service use data. We did not find evidence that the CTM could predict home healthcare patients having an elevated risk for emergent care, rehospitalization, or higher home health nursing use. Because Medicare/Medicaid-certified home healthcare providers already use a comprehensive, mandated start of care assessment, the CTM may not provide them additional crucial information. Process and outcome measurement is increasingly becoming part of usual care. Selection of measures appropriate for each service setting requires thorough site-specific evaluation. In light of our findings, we cannot recommend the CTM as an additional measure in the home healthcare setting.

Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis

BACKGROUND

The association between depression after myocardial infarction and increased risk of mortality and cardiac morbidity may be due to cardiac disease severity.

AIMS

To combine original data from studies on the association between post-infarction depression and prognosis into one database, and to investigate to what extent such depression predicts prognosis independently of disease severity.

METHOD

An individual patient data meta-analysis of studies was conducted using multilevel, multivariable Cox regression analyses.

RESULTS

Sixteen studies participated, creating a database of 10 175 post-infarction cases. Hazard ratios for post-infarction depression were 1.32 (95% CI 1.26-1.38, P<0.001) for all-cause mortality and 1.19 (95% CI 1.14-1.24, P<0.001) for cardiovascular events. Hazard ratios adjusted for disease severity were attenuated by 28% and 25% respectively.

CONCLUSIONS

The association between depression following myocardial infarction and prognosis is attenuated after adjustment for cardiac disease severity. Still, depression remains independently associated with prognosis, with a 22% increased risk of all-cause mortality and a 13% increased risk of cardiovascular events per standard deviation in depression z-score.

In patients with stable heart failure, soluble TNF-receptor 2 is associated with increased risk for depressive symptoms

OBJECTIVES

Researchers have proposed biological (inflammation) and psychological (depression) factors as potential mechanisms for poorer outcomes and readmissions in heart failure (HF) patients. However, studies investigating the link between inflammation and depressive symptoms in these patients are few. We examined the relationships between levels of the inflammatory markers C-reactive protein (CRP), interleukin (IL)-6, and soluble tumor necrosis factor receptor 2 (sTNR2) and depressive symptoms in HF outpatients.

METHOD

55 patients (74.5% men; 60% Whites; mean age 71.6 ± 11.3 years) with New York Heart Association Class II, III, or IV HF (49%, 47%, and 4%, respectively) and mean ejection fraction (EF) 29.9 ± 7.1% completed the Patient Health Questionnaire (PHQ)-9 as a measure of depressive symptoms. We also obtained height, weight, and CRP, IL-6, and sTNFR2 levels. We used multivariate regressions to assess the predictive value of PHQ-9 scores on each inflammatory marker.

RESULTS

22 (40%) participants reported depressive symptoms (PHQ-9 score ≥ 5). After controlling for age, gender, body mass index, HF etiology, EF, and statin use, we found significant relationships between levels of both sTNFR2 (β = .35, p = .01) and IL-6 (β = .30, p = .04), but not CRP (β = -.96, p = .52), and depression scores.

CONCLUSION

Our findings add to a growing body of evidence supporting the proposition that heightened inflammation explains the effect depression has on HF. Health care providers should screen for depression in HF patients, as they may be at higher risk of augmented inflammation and poor outcomes.

Psychometrics of the PHQ-9 as a measure of depressive symptoms in patients with heart failure

BACKGROUND

Depression in patients with heart failure commonly goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) is a simple, valid measure of depressive symptoms that may facilitate clinical assessment. It has not been validated in patients with heart failure.

AIMS

To test the reliability, and concurrent and construct validity of the PHQ-9 in patients with heart failure.

METHODS

A total of 322 heart failure patients (32% female, 61 ± 12 years, 56% New York Heart Association class III/IV) completed the PHQ-9, the Beck Depression Inventory-II (BDI-II), and the Control Attitudes Scale (CAS).

RESULTS

Cronbach's alpha of .83 supported the internal consistency reliability of the PHQ-9 in this sample. Inter-item correlations (range .22-.66) and item-total correlation (except item 9) supported homogeneity of the PHQ-9. Spearman's rho of .80, (p < .001) between the PHQ-9 and the BDI-II supported the concurrent validity as did the agreement between the PHQ-9 and the BDI-II (Kappa = 0.64, p < .001). At cut-off score of 10, the PHQ-9 was 70% sensitive and 92% specific in identifying depressive symptoms, using the BDI-II scores as the criterion for comparison. Differences in PHQ-9 scores by level of perceived control measured by CAS (t(318) = -5.05, p < .001) supported construct validity.

CONCLUSION

The PHQ-9 is a reliable, valid measure of depressive symptoms in patients with heart failure.

A self-help behavioral activation treatment for geriatric depressive symptoms

This study investigated behavioral activation (BA) bibliotherapy as a treatment for late-life depressive symptoms. BA bibliotherapy was administered using Addis and Martell's Overcoming depression one step at a time as a stand-alone treatment that was completed by participants (N=26) over a 4-week period [Addis, M.E., & Martell, C.R. (2004). Overcoming depression one step at a time. Oakland, CA: New Harbinger Publications, Inc.]. Results of an immediate intervention group were compared with those of a delayed treatment control group and treatment response for both groups was evaluated at 1-month follow-up. Primary outcome results showed that symptoms on a clinician-rated measure of depressive symptoms, Hamilton Rating Scale for Depression, were significantly lower at post-treatment for those who received immediate BA bibliotherapy compared with those who were in the delayed treatment control condition. However, self-reported depressive symptoms (a secondary outcome measured via the Geriatric Depression Scale), were not significantly different at this period. Because study control was lost after the delayed treatment group received the intervention, within-subjects analyses examining both treatment groups combined showed that clinician-rated depressive symptoms significantly decreased from pre-treatment to both post-treatment and 1-month follow-up. Self-reported depressive symptoms were significantly lower from pre-treatment to 1-month follow-up. These findings suggest that BA may be useful in treating mild or subthreshold depressive symptoms in an older adult population.

Depression-focused interpersonal counseling and the use of healthcare services after myocardial infarction

PURPOSE

The purpose for this study was to evaluate the association between depression-focused interpersonal counseling (IPC) and the use of healthcare services in Finland after myocardial infarction (MI).

DESIGN AND METHODS

The measures were done at 6 and 18 months after MI in the randomized intervention (n= 51) and the control group (n= 52).

FINDINGS

There was less use of somatic specialized healthcare services in the intervention group from 6 to 18 months after hospital discharge, and with intervention patients who had no other long-term disease during 6 months.

PRACTICE IMPLICATIONS

Confirmation of possible benefits of IPC for practice calls for more specific studies.

Relationship of persistent symptoms of anxiety to morbidity and mortality outcomes in patients with coronary heart disease

OBJECTIVE

To examine the association of symptoms of persistent anxiety with the development of acute cardiac events in patients with coronary heart disease (CHD) followed for 2 years. The prevalence of symptoms of anxiety is high in patients with CHD, but their effect on cardiac events and mortality has not been well characterized.

METHODS

Of 3522 patients with confirmed CHD enrolled, data on symptoms of anxiety were available at two time points in 3048 patients who were then followed up for detection of the composite end point of hospitalization for myocardial infarction, unstable or stable angina, other cardiac causes, or all-cause mortality. A composite anxiety symptoms score composed of baseline and 3-month anxiety data, in which the continuous-level scores were used, was tested using Cox proportional hazards regression model. Groups (persistent anxiety [anxiety at both time points] versus nonanxious [no anxiety at either time point] versus not persistently anxious [anxiety only at one time point]) were also compared.

RESULTS

Symptoms of persistent anxiety, whether considered as a continuous- or categorical-level variable, were associated with shorter time to event. Persistent anxiety remained as an independent predictor of the end point after controlling for multiple variables (persistent anxiety as a summary score [hazard ratio = 1.27, 95% confidence interval = 1.067-1.514] and persistent anxiety as a categorical variable [hazard ratio = 1.52, 95% confidence interval = 1.149-2.015]).

CONCLUSIONS

By measuring anxiety symptoms at more than one time point and controlling for relevant sociodemographic, comorbidity, risk factor, and psychological covariates, we illustrate that symptoms of persistent anxiety are a strong, independent predictor of cardiac event-free survival.

Depressive symptoms and change in abdominal obesity in the elderly: positive or negative association?

OBJECTIVES

Recent evidence suggests that depression can result in abdominal obesity in the elderly. Few longitudinal studies are available and none has been conducted outside the United States.

METHODS

To examine the relationship between depressive symptoms and abdominal obesity, data from 3,998 community-dwelling Chinese elderly men and women age 65 years and older with 4-year follow-up were analyzed. Depression was defined by a Geriatric Depression Scale score of 8 or higher. At baseline and after 4 years, overall obesity measures included body mass index, percentage of body fat, and general adiposity or body fat index (expressed by total body fat mass measured by DEXA (dual-energy x-ray absorptiometry) in kilograms divided by the square of stature in meters). Abdominal obesity measures included waist circumference, waist to hip ratio, and relative truncal fat (ratio of truncal fat mass to total fat mass measured by DEXA).

RESULTS

After adjustment for sociodemographics, lifestyle, and medical factors, the presence of clinically relevant depressive symptoms at baseline was associated with significant decrease in waist circumference at follow-up after adjusting for sociodemographic factors, baseline obesity, lifestyle, and medical factors (β = -1.801, t = -2.93, df = 1564, p = 0.0034), although this relationship disappeared in older age women in further age-stratified analysis.

CONCLUSIONS

This study shows that depressive symptoms may result in a decrease in abdominal obesity, suggesting that more research is needed to further explore this relationship. Similar studies conducted in different cultural groups may help to explain these conflicting findings.