1
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Wang M, Cheng L, Gao Z, Li J, Ding Y, Shi R, Xiang Q, Chen X. Investigation of the shared molecular mechanisms and hub genes between myocardial infarction and depression. Front Cardiovasc Med 2023; 10:1203168. [PMID: 37547246 PMCID: PMC10401437 DOI: 10.3389/fcvm.2023.1203168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Background The pathogenesis of myocardial infarction complicating depression is still not fully understood. Bioinformatics is an effective method to study the shared pathogenesis of multiple diseases and has important application value in myocardial infarction complicating depression. Methods The differentially expressed genes (DEGs) between control group and myocardial infarction group (M-DEGs), control group and depression group (D-DEGs) were identified in the training set. M-DEGs and D-DEGs were intersected to obtain DEGs shared by the two diseases (S-DEGs). The GO, KEGG, GSEA and correlation analysis were conducted to analyze the function of DEGs. The biological function differences of myocardial infarction and depression were analyzed by GSVA and immune cell infiltration analysis. Four machine learning methods, nomogram, ROC analysis, calibration curve and decision curve were conducted to identify hub S-DEGs and predict depression risk. The unsupervised cluster analysis was constructed to identify myocardial infarction molecular subtype clusters based on hub S-DEGs. Finally, the value of these genes was verified in the validation set, and blood samples were collected for RT-qPCR experiments to further verify the changes in expression levels of these genes in myocardial infarction and depression. Results A total of 803 M-DEGs, 214 D-DEGs, 13 S-DEGs and 6 hub S-DEGs (CD24, CSTA, EXTL3, RPS7, SLC25A5 and ZMAT3) were obtained in the training set and they were all involved in immune inflammatory response. The GSVA and immune cell infiltration analysis results also suggested that immune inflammation may be the shared pathogenesis of myocardial infarction and depression. The diagnostic models based on 6 hub S-DEGs found that these genes showed satisfactory combined diagnostic performance for depression. Then, two molecular subtypes clusters of myocardial infarction were identified, many differences in immune inflammation related-biological functions were found between them, and the hub S-DEGs had satisfactory molecular subtypes identification performance. Finally, the analysis results of the validation set further confirmed the value of these hub genes, and the RT-qPCR results of blood samples further confirmed the expression levels of these hub genes in myocardial infarction and depression. Conclusion Immune inflammation may be the shared pathogenesis of myocardial infarction and depression. Meanwhile, hub S-DEGs may be potential biomarkers for the diagnosis and molecular subtype identification of myocardial infarction and depression.
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Affiliation(s)
- Mengxi Wang
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Liying Cheng
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ziwei Gao
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianghong Li
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuhan Ding
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ruijie Shi
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qian Xiang
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaohu Chen
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
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2
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Chen X, Zeng M, Chen C, Zhu D, Chen L, Jiang Z. Efficacy of Psycho-Cardiology therapy in patients with acute myocardial infarction complicated with mild anxiety and depression. Front Cardiovasc Med 2023; 9:1031255. [PMID: 36776943 PMCID: PMC9909477 DOI: 10.3389/fcvm.2022.1031255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/20/2022] [Indexed: 01/27/2023] Open
Abstract
Objective To evaluate the efficacy of Psycho-Cardiology therapy among patients with acute myocardial infarction (AMI) complicated with mild anxiety and depression. Methods Two hundred and fifty-six patients with AMI who were admitted to the Cardiovascular Department of Chenzhou First People's Hospital from January 2018 to January 2020 were selected as subjects, and randomly divided into the control group (n = 128) and the Psycho-Cardiology treatment group (n = 128). Prior to the intervention, the general clinical data of the enrolled patients, such as gender, age, comorbidities (hypertension, diabetes) and smoking history, were compared, which revealed no statistical differences between the two groups (P > 0.05). The control group was given routine treatments such as reperfusion and secondary prevention of coronary heart disease, while the treatment group was given Psycho-Cardiology intervention in addition to the aforementioned treatments. Results No significant differences in PHQ-9 and GAD-7 scores were observed between the control and treatment groups at admission (P > 0.05). After the Psycho-Cardiology treatment, the PHQ-9 and GAD-7 scores of the treatment group decreased significantly. Based on the 1-year post-treatment comparison, the left ventricular ejection fraction was improved more significantly in the Psycho-Cardiology treatment group, showing statistical significance (P < 0.05). The treatment group exhibited statistically significantly low incidences of adverse cardiovascular events, such as recurrent angina pectoris, heart failure, malignant arrhythmia, recurrent myocardial infarction and death (P < 0.05). Conclusions Psycho-Cardiology therapy is remarkably efficacious in improving the anxiety, depression, cardiac function and reducing the occurrence of adverse cardiovascular events, which can better improve the long-term prognosis of patients with AMI compared to the traditional treatments.
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Affiliation(s)
- Xiaoliang Chen
- The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, China,*Correspondence: Xiaoliang Chen ✉
| | - Mengya Zeng
- The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Chen Chen
- The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, China
| | - Dan Zhu
- The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, China
| | - Li Chen
- The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, China
| | - Zuying Jiang
- The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, China
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3
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Liblik K, Théberge E, Gomes Z, Burbidge E, Menon N, Gobran J, Johri AM. Improving Wellbeing After Acute Coronary Syndrome. Curr Probl Cardiol 2022:101201. [DOI: 10.1016/j.cpcardiol.2022.101201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 11/15/2022]
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4
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Sundbøll J, Szépligeti SK, Szentkúti P, Adelborg K, Horváth-Puhó E, Pedersen L, Henderson VW, Sørensen HT. Risk of Parkinson Disease and Secondary Parkinsonism in Myocardial Infarction Survivors. J Am Heart Assoc 2022; 11:e022768. [PMID: 35170978 PMCID: PMC9075091 DOI: 10.1161/jaha.121.022768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In addition to primary neurodegenerative processes, vascular disorders, such as stroke, can lead to parkinsonism. However, some cardiovascular risk factors, such as smoking and elevated cholesterol levels, are associated with reduced risk of Parkinson disease. We examined the risk of Parkinson disease and secondary parkinsonism in 1‐year survivors of myocardial infarction (MI). Methods and Results We conducted a nationwide population‐based matched cohort study using Danish medical registries from 1995 to 2016. We identified all patients with a first‐time MI diagnosis and sampled a sex‐, age‐, and calendar year–matched general population comparison cohort without MI. Cox regression analysis was used to compute adjusted hazard ratios (aHRs) for Parkinson disease and secondary parkinsonism, controlled for matching factors and adjusted for relevant comorbidities and socioeconomic factors. We identified 181 994 patients with MI and 909 970 matched comparison cohort members (median age, 71 years; 62% men). After 21 years of follow‐up, the cumulative incidence was 0.9% for Parkinson disease and 0.1% for secondary parkinsonism in the MI cohort. Compared with the general population cohort, MI was associated with a decreased risk of Parkinson disease (aHR, 0.80; 95% CI, 0.73–0.87) and secondary parkinsonism (aHR, 0.72; 95% CI, 0.54–0.94). Conclusions MI was associated with a 20% decreased risk of Parkinson disease and 28% decreased risk of secondary parkinsonism. Reduced risk may reflect an inverse relationship between cardiovascular risk factors and Parkinson disease.
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Affiliation(s)
- Jens Sundbøll
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark.,Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | | | - Péter Szentkúti
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
| | | | - Lars Pedersen
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
| | - Victor W Henderson
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark.,Departments of Epidemiology and Population Health Stanford University Stanford CA.,Departments of Neurology and Neurological Sciences Stanford University Stanford CA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark.,Departments of Epidemiology and Population Health Stanford University Stanford CA.,Departments of Neurology and Neurological Sciences Stanford University Stanford CA
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Liblik K, Mulvagh SL, Hindmarch CCT, Alavi N, Johri AM. Depression and anxiety following acute myocardial infarction in women. Trends Cardiovasc Med 2021; 32:341-347. [PMID: 34363978 DOI: 10.1016/j.tcm.2021.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease is the leading global cause of mortality, with ischemic heart disease causing the majority of cardiovascular deaths. Despite this, diagnostic delay commonly occurs in women experiencing acute myocardial infarction (AMI) who have a higher associated in-hospital mortality. Several studies have demonstrated that women are significantly more likely than men to experience depression and anxiety following AMI which is linked with increased morbidity, rehospitalization, and mortality, as well as decreased quality of life. Thus, it is imperative that future work aims to understand the factors that put women at higher risk for depression and anxiety following AMI, informing prevention and intervention. This narrative review will summarize the current literature on the association between AMI and mental health in women, including the impact on morbidity, mortality, and quality of life.
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Affiliation(s)
- Kiera Liblik
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Sharon L Mulvagh
- Department of Medicine, Division of Cardiology, Dalhousie University, Halifax, NS, Canada
| | - Charles C T Hindmarch
- Queen's Cardiopulmonary Unit, Translational Institute of Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Nazanin Alavi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Amer M Johri
- Department of Medicine, Cardiovascular Imaging Network at Queen's University, Kingston, ON, Canada.
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6
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Yang Y, Li X, Chen S, Xiao M, Liu Z, Li J, Cheng Y. Mechanism and therapeutic strategies of depression after myocardial infarction. Psychopharmacology (Berl) 2021; 238:1401-1415. [PMID: 33594503 DOI: 10.1007/s00213-021-05784-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 02/04/2021] [Indexed: 01/08/2023]
Abstract
Depression resulted as an important factor associated with the myocardial infarction (MI) prognosis. Patients with MI also have a higher risk for developing depression. Although the issue of depression after MI has become a matter of clinical concern, the molecular mechanism underlying depression after MI remains unclear, whereby several strategies suggested have not got ideal effects, such as selective serotonin reuptake inhibitors. In this review, we summarized and discussed the occurrence mechanism of depression after MI, such as 5-hydroxytryptamine (5-HT) dysfunction, altered hypothalamus-pituitary-adrenal (HPA) axis function, gut microbiota imbalance, exosomal signal transduction, and inflammation. In addition, we offered a succinct overview of treatment, as well as some promising molecules especially from natural products for the treatment of depression after MI.
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Affiliation(s)
- Ying Yang
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China
| | - Xuping Li
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China
| | - Sixuan Chen
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China
| | - Mingzhu Xiao
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China
| | - Zhongqiu Liu
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China
| | - Jingyan Li
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China.
| | - Yuanyuan Cheng
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China.
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7
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Pre-existing psychiatric disorder is related to lower mortality from road traffic accident: A Japanese nationwide retrospective cohort study. Injury 2021; 52:1390-1395. [PMID: 33663800 DOI: 10.1016/j.injury.2021.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/25/2020] [Accepted: 02/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous studies have reported inconsistent results on the mortality from trauma among psychiatric patients comparing to non-psychiatric population, which may be partly explained by the inclusion of both suicidal and accidental trauma. This study aimed to investigate the association of psychiatric diagnoses on admission with the outcomes of hospitalized patients for accidental trauma, namely road traffic injury. METHODS Detailed information of patients aged 15 years or older who were hospitalized for road traffic injury between 2004 and 2017 was extracted from the Japan Trauma Data Bank. The primary outcome was to compare in-hospital mortality between patients with and without a psychiatric disorder. We also conducted a subgroup analysis among patients with and without a serious head injury. RESULTS Altogether, 85,069 patients were included. Of these, 3,895 patients (4.6%) had a psychiatric diagnosis. The in-hospital mortality rate was significantly lower among patients with a psychiatric diagnosis than those without (5.4% vs. 8.3%; adjusted odds ratio [OR] 0.57, 95% confidence interval [CI] 0.47-0.70, p<0.001). In a subgroup analysis of patients with a serious head injury, in-hospital mortality was significantly lower in patients with a psychiatric diagnosis than in those without (10.5% vs. 17.3%; adjusted OR 0.48, 95% CI 0.37-0.62, p<0.001); in-hospital mortality of patients without a serious head injury showed no differences between patients with or without a psychiatric diagnosis (2.8% vs. 3.5%; adjusted OR 0.84, 95% CI 0.61-1.16, p=0.295). CONCLUSIONS In-hospital mortality from road traffic injury was significantly lower among patients with a psychiatric diagnosis than those without, which was primarily evident in a subgroup of patients with a serious head injury. While further replication is necessary, results might be indicative of the neuroprotective effect of psychotropic medications.
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8
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Humphries SM, Wallert J, Norlund F, Wallin E, Burell G, von Essen L, Held C, Olsson EMG. Internet-Based Cognitive Behavioral Therapy for Patients Reporting Symptoms of Anxiety and Depression After Myocardial Infarction: U-CARE Heart Randomized Controlled Trial Twelve-Month Follow-up. J Med Internet Res 2021; 23:e25465. [PMID: 34028358 PMCID: PMC8185614 DOI: 10.2196/25465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/24/2020] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The U-CARE Heart trial was one of the first randomized controlled trials to evaluate the effect of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety or depression for patients with a recent myocardial infarction. While the effects of internet-based cognitive behavioral therapy on Hospital Anxiety and Depression Scale (HADS) scores at 14 weeks postbaseline were not significant, in this study, we investigated possible long-term effects of treatment. OBJECTIVE The aim of this study was to evaluate the long-term effectiveness of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety and depression in patients 12 months after a myocardial infarction and to explore subsequent occurrences of cardiovascular disease events. METHODS Shortly after acute myocardial infarction, 239 patients (33% female, mean age 59.6 years) reporting mild-to-moderate symptoms of anxiety or depression were randomized to 14 weeks of therapist-guided internet-based cognitive behavioral therapy (n=117) or treatment as usual (n=122). Data from national registries were used to explore group differences in clinical outcomes such as cardiovascular disease and cardiovascular-related mortality for a follow-up period of up to 5 years: group differences in HADS total score 1 year post-myocardial infarction, the primary outcome, was analyzed using multiple linear regression. Secondary outcomes, such as HADS anxiety and depression subscales and the Cardiac Anxiety Questionnaire total score (CAQ), which measures heart-focused anxiety, were analyzed in the same way. Multiple imputation was used to account for missing data, and a pooled treatment effect was estimated. Adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) for data pertaining to registry outcomes. RESULTS Both groups reported lower HADS total scores 1 year after myocardial infarction than those at baseline. HADS total scores were not significantly different between the treatment and control groups 1 year after myocardial infarction (β=-1.14, 95% CI -2.73 to 0.45, P=.16). CAQ was the only measure improved significantly by internet-based cognitive behavioral therapy when compared with treatment as usual (β=-2.58, 95% CI -4.75 to -0.42, P=.02) before adjusting for multiple comparisons. The composite outcome of nonfatal cardiovascular events and cardiovascular-related mortality did not differ between groups but was numerically higher in the internet-based cognitive behavioral therapy group, who were at slightly greater risk (HR 1.8, 95% CI 0.96 to 3.4, P=.07). Adjusting for previous myocardial infarction and diabetes attenuated this estimate (HR 1.5, 95% CI 0.8 to 2.8, P=.25). CONCLUSIONS Internet-based cognitive behavioral therapy was not superior in reducing self-reported symptoms of depression or anxiety compared to treatment as usual at the 1-year follow-up after myocardial infarction. A reduction in cardiac-related anxiety was observed but was not significant after adjusting for multiple comparisons. There was no difference in risk of cardiovascular events between the treatment groups. Low treatment adherence, which might have affected treatment engagement and outcomes, should be considered when interpreting these results. TRIAL REGISTRATION ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-015-0689-y.
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Affiliation(s)
- Sophia Monica Humphries
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - John Wallert
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Fredrika Norlund
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Wallin
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Gunilla Burell
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Family Medicine and Preventative Medicine, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Claes Held
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Cardiology, Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Erik Martin Gustaf Olsson
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Park J, Park S, Kim YG, Ann SH, Park HW, Suh J, Roh JH, Cho YR, Han S, Park GM. Pre-existing depression in patients with coronary artery disease undergoing percutaneous coronary intervention. Sci Rep 2021; 11:8600. [PMID: 33883579 PMCID: PMC8060426 DOI: 10.1038/s41598-021-87907-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/06/2021] [Indexed: 11/25/2022] Open
Abstract
The impact of pre-existing depression on mortality in individuals with established coronary artery disease (CAD) remains unclear. We evaluate the clinical implications of pre-existing depression in patients who underwent percutaneous coronary intervention (PCI). Based on National Health Insurance claims data in Korea, patients without a known history of CAD who underwent PCI between 2013 and 2017 were enrolled. The study population was divided into patients with angina (n = 50,256) or acute myocardial infarction (AMI; n = 40,049). The primary endpoint, defined as all-cause death, was compared between the non-depression and depression groups using propensity score matching analysis. After propensity score matching, there were 4262 and 2346 matched pairs of patients with angina and AMI, respectively. During the follow-up period, there was no significant difference in the incidence of all-cause death in the angina (hazard ratio [HR] of depression, 1.013; 95% confidence interval [CI] 0.893–1.151) and AMI (HR, 0.991; 95% CI 0.865–1.136) groups. However, angina patients less than 65 years of age with depression had higher all-cause mortality (HR, 1.769; 95% CI 1.240–2.525). In Korean patients undergoing PCI, pre-existing depression is not associated with poorer clinical outcomes. However, in younger patients with angina, depression is associated with higher all-cause mortality.
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Affiliation(s)
- Jangho Park
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Sangwoo Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Yong-Giun Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Soe Hee Ann
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Hyun Woo Park
- Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon, Republic of Korea
| | - Jon Suh
- Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon, Republic of Korea
| | - Jae-Hyung Roh
- Department of Cardiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Young-Rak Cho
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Seungbong Han
- Department of Biostatistics, College of Medicine, Korea University, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Gyung-Min Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
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Sever S, Doherty P, Golder S, Harrison AS. Is improvement in depression in patients attending cardiac rehabilitation with new-onset depressive symptoms determined by patient characteristics? Open Heart 2020; 7:openhrt-2020-001264. [PMID: 32847994 PMCID: PMC7451288 DOI: 10.1136/openhrt-2020-001264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
Background Patients with cardiovascular disease (CVD) commonly experience depressive symptoms which is associated with adverse outcome and increased mortality. Examining the baseline characteristics of cardiac rehabilitation (CR) patients that determine Hospital Anxiety and Depression Scale (HADS) depression outcome may facilitate adjustments in CR programme delivery. This study aims to investigate whether comorbidities, demographic and clinical characteristics of patients, with new-onset post-cardiac event depressive symptoms, determine change in their depression following CR. Methods Analysing the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation between April 2012 and March 2018, an observational study was conducted. Patients with new-onset post-cardiac event depressive symptoms and no previous documented history of depression constituted the study population. Results The analyses included 64 658 CR patients (66.24±10.69 years, 75% male) with new-onset HADS measures, excluding patients with a history of depression. The comorbidities determining reduced likelihood of improvement in depression outcomes after CR were angina, diabetes, stroke, emphysema and chronic back problems. In addition, higher total number of comorbidities, increased weight, a higher HADS anxiety score, smoking at baseline, physical inactivity, presence of heart failure and being single were other significant determinants. However, receiving coronary artery bypass graft treatment was associated with better improvement. Conclusion The study identified specific baseline comorbid conditions of patients with new-onset depressive symptoms including angina, diabetes, stroke, emphysema and chronic back problems that were determinants of poorer mental health outcomes (HADS) following CR. Higher total number of comorbidities, increased weight, physical inactivity, smoking, presence of heart failure and being single were other determinants of a negative change in depression. These findings could help CR programmes focus on tailoring the CR intervention around comorbidity, physical activity status, weight management and smoking cessation in patients with new-onset depressive symptoms.
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Affiliation(s)
- Serdar Sever
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Su Golder
- Department of Health Sciences, University of York, York, North Yorkshire, UK
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Zinckernagel L, Ersbøll AK, Holmberg T, Pedersen SS, Timm HU, Zwisler AD. What are the prevalence and predictors of psychosocial healthcare among patients with heart disease? A nationwide population-based cohort study. BMJ Open 2020; 10:e037691. [PMID: 33040000 PMCID: PMC7549489 DOI: 10.1136/bmjopen-2020-037691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Psychosocial healthcare is recommended, but little is known about how patients perceive the level of care and whether subgroups of patients experience less psychosocial healthcare than others. We examined the prevalence of patient-reported psychosocial healthcare and factors predicting patient-reported lack of psychosocial healthcare among patients with heart disease. DESIGN A cohort study. SETTING Denmark, nationwide. PARTICIPANTS A registry-based random sample of 5000 patients with incident heart disease in 2013. MEASURES Patient-reported psychosocial healthcare was obtained from a survey and potential predictors before disease onset from registries. We used multivariable logistic regression analysis to determine predictors of patient-reported lack of care. RESULTS We received responses from 56%; 40% reported lacking information on psychosocial aspects, 51% lacking psychosocial rehabilitation and support and 32% reported lacking both types of psychosocial healthcare. The type of heart disease was the strongest predictor of patient-reported lack of psychosocial healthcare, especially among patients with atrial fibrillation (OR: 3.11-3.98). Older age (OR: 1.48-2.05), female gender (OR: 1.27-1.53) and no contact with general practitioner (OR: 1.47-1.84) also predicted patient-reported lack of psychosocial healthcare. Patients outside the labour force (OR: 1.29) and living in the capital region (OR: 1.50) more frequently reported lacking psychosocial rehabilitation and support, and patients with recent (OR: 1.63) or past (OR: 1.33) anxiety or depression and severe comorbidities (OR: 1.34) more frequently reported lacking both types of psychosocial healthcare. CONCLUSIONS Many patients with heart disease reported lacking psychosocial healthcare. Importantly, patients who most need psychosocial healthcare are not those who report receiving it. Our results call for action to translate guidelines into clinical practice.
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Affiliation(s)
- Line Zinckernagel
- The National Institute of Public Health, the University of Southern Denmark, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, the University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
| | - Annette Kjær Ersbøll
- The National Institute of Public Health, the University of Southern Denmark, Odense, Denmark
| | - Teresa Holmberg
- The National Institute of Public Health, the University of Southern Denmark, Odense, Denmark
| | - Susanne S Pedersen
- Department of Psychology, the University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Helle Ussing Timm
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, the University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, the University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
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12
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Kowal C, Peyre H, Amad A, Pelissolo A, Leboyer M, Schürhoff F, Pignon B. Psychotic, Mood, and Anxiety Disorders and Venous Thromboembolism: A Systematic Review and Meta-Analysis. Psychosom Med 2020; 82:838-849. [PMID: 32947580 DOI: 10.1097/psy.0000000000000863] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Several studies have shown that psychiatric disorders can be associated with venous thromboembolism (VTE) risk, that is, pulmonary embolism (PE) and/or deep vein thrombosis (DVT). In this study, we provide a systematic review and meta-analyses of the studies addressing this issue. METHODS All studies addressing the risk of VTE phenomena (whole VTE, PE, DVT, fatal VTE) in individuals with psychotic, mood, and anxiety disorders published between 1998 and 2019 were reviewed and included in the meta-analyses. Main characteristics of the studies and data concerning VTE risk were extracted. The methodological qualities of the studies were also analyzed. A random-effects meta-analysis model was used. A meta-analysis was conducted separately for each disorder, as well as separately for unadjusted and adjusted studies. Meta-analyses were repeated considering only good-quality studies. Heterogeneity was assessed. RESULTS Sixteen studies were reviewed and 15 included in the meta-analyses. Psychotic and bipolar disorders were significantly associated with VTE risk (VTE, DVT, PE, and fatal VTE for psychotic disorder: odds ratios [ORs] between 1.29 and 2.20; VTE, DVT, and PE for bipolar disorder: ORs between 1.22 and 2.14). Depression and anxiety disorders were associated with VTE risk only in adjusted analyses (DVT and PE for depression: ORs = 1.29; VTE and PE for anxiety disorders: ORs between 1.14 and 1.49). CONCLUSIONS The risk of VTE among individuals with psychiatric disorders may be explained by hypercoagulability and stasis, with both being related to, and independent of, treatment adverse effects. VTE risk should be taken into consideration in the treatment for people with psychiatric disorders.
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Affiliation(s)
- Célia Kowal
- From the AP-HP, GH Henri Mondor (Kowal), Service de pharmacie, Créteil; AP-HP, Hôpital universitaire Robert Debré (Peyre), Service de pédopsychiatrie, Paris; AP-HP, DMU IMPACT, GH Henri Mondor (Pelissolo, Leboyer, Schürhoff, Pignon), Service de Psychiatrie; Inserm, U955, team 15 (Pelissolo, Leboyer, Schürhoff, Pignon); Fondation FondaMental (Pelissolo, Leboyer, Schürhoff, Pignon); UPEC, Université Paris-Est Créteil Faculté de médecine (Pelissolo, Leboyer, Schürhoff, Pignon), Créteil; Univ. Lille, CNRS UMR 9193-PsyCHIC-SCALab, and CHU Lille (Amad), Pôle de Psychiatrie, Unité CURE; Fédération régionale de recherche en santé mentale (F2RSM) Hauts-de-France (Amad), Lille, France; and Institute of Psychiatry, Psychology and Neuroscience (Amad), College London, London, United Kingdom
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13
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Sever S, Doherty P, Harrison AS, Golder S. To what extent is multi-morbidity associated with new onset depression in patients attending cardiac rehabilitation? BMC Cardiovasc Disord 2019; 19:256. [PMID: 31726981 PMCID: PMC6857318 DOI: 10.1186/s12872-019-1245-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/06/2019] [Indexed: 11/21/2022] Open
Abstract
Background Depression is associated with increased mortality and poor prognosis in patients with cardiovascular disease (CVD). However, little is known about the patient characteristics associated with new onset post heart event depressive symptoms, specifically medical comorbidities, among cardiac rehabilitation (CR) participants. Therefore, this paper examines the comorbidity profile and characteristics associated with new onset depressive symptoms in patients attending CR. Methods An observational study using the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation (NACR) from the last six years between April 2012 and March 2018. Patients with new onset post heart event depression and no previous documented history of depression were selected as the study population. An independent samples t-test and chi square tests were used to compare the association between new onset depressive symptoms and patient variables including demographics, clinical measures and comorbidities. A binary logistic regression was conducted to investigate the predictors of new onset depressive symptoms employing log-likelihood ratio statistic. Results The analyses included 109,055 CR patients with new onset depression measured by Hospital Anxiety and Depression Scale (HADS). At baseline assessment, comorbidity measures associated with new onset depressive symptoms were increased total number of comorbidities and a range of comorbidities - including diabetes, angina, arthritis, chronic back problems, asthma, stroke, anxiety, rheumatism, claudication, osteoporosis, chronic bronchitis and emphysema. After multivariate adjustments were done, at the start of CR, the significant predictors of new onset depressive symptoms were physical inactivity, high HADS anxiety score measurement, increased weight, total number of comorbidities, diabetes, stroke, chronic back problems, being from areas with higher levels of social deprivation, being single, and male. Conclusion The research findings establish new insights into the association between patient demographic and clinical variables across a range of comorbidities in patients with new onset post heart event depressive symptoms. At the start of CR, patients with new onset depressive symptoms need to be assessed skilfully as they tend to have a complex multi-morbid presentation linked to psychosocial risk factors known to hinder CR engagement.
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Affiliation(s)
- Serdar Sever
- Department of Health Sciences, Faculty of Science, University of York, York, UK.
| | - Patrick Doherty
- Department of Health Sciences, Faculty of Science, University of York, ATB/255 Seebohm Rowntree Building, York, UK
| | - Alexander Stephen Harrison
- Department of Health Sciences, Faculty of Science, University of York, ATB/255 Seebohm Rowntree Building, York, UK
| | - Su Golder
- Department of Health Sciences, Faculty of Science, University of York, ATB/255 Seebohm Rowntree Building, York, UK
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14
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Schmidt M, Schmidt SAJ, Adelborg K, Sundbøll J, Laugesen K, Ehrenstein V, Sørensen HT. The Danish health care system and epidemiological research: from health care contacts to database records. Clin Epidemiol 2019; 11:563-591. [PMID: 31372058 PMCID: PMC6634267 DOI: 10.2147/clep.s179083] [Citation(s) in RCA: 720] [Impact Index Per Article: 144.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/20/2019] [Indexed: 01/04/2023] Open
Abstract
Denmark has a large network of population-based medical databases, which routinely collect high-quality data as a by-product of health care provision. The Danish medical databases include administrative, health, and clinical quality databases. Understanding the full research potential of these data sources requires insight into the underlying health care system. This review describes key elements of the Danish health care system from planning and delivery to record generation. First, it presents the history of the health care system, its overall organization and financing. Second, it details delivery of primary, hospital, psychiatric, and elderly care. Third, the path from a health care contact to a database record is followed. Finally, an overview of the available data sources is presented. This review discusses the data quality of each type of medical database and describes the relative technical ease and cost-effectiveness of exact individual-level linkage among them. It is shown, from an epidemiological point of view, how Denmark’s population represents an open dynamic cohort with complete long-term follow-up, censored only at emigration or death. It is concluded that Denmark’s constellation of universal health care, long-standing routine registration of most health and life events, and the possibility of exact individual-level data linkage provides unlimited possibilities for epidemiological research.
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Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
| | - Sigrun Alba Johannesdottir Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sundbøll
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kristina Laugesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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15
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Cocchio S, Baldovin T, Furlan P, Buja A, Casale P, Fonzo M, Baldo V, Bertoncello C. Is depression a real risk factor for acute myocardial infarction mortality? A retrospective cohort study. BMC Psychiatry 2019; 19:122. [PMID: 31014311 PMCID: PMC6480593 DOI: 10.1186/s12888-019-2113-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression has been associated with a higher risk of cardiovascular events and a higher mortality in patients with one or more comorbidities. This study investigated whether continuative use of antidepressants (ADs), considered as a proxy of a state of depression, prior to acute myocardial infarction (AMI) is associated with a higher mortality afterwards. The outcome to assess was mortality by AD use. METHODS A retrospective cohort study was conducted in the Veneto Region on hospital discharge records with a primary diagnosis of AMI in 2002-2015. Subsequent deaths were ascertained from mortality records. Drug purchases were used to identify AD users. A descriptive analysis was conducted on patients' demographics and clinical data. Survival after discharge was assessed with a Kaplan-Meier survival analysis and Cox's multiple regression model. RESULTS Among 3985 hospital discharge records considered, 349 (8.8%) patients were classified as 'AD users'. The mean AMI-related hospitalization rate was 164.8/100,000 population/year, and declined significantly from 204.9 in 2002 to 130.0 in 2015, but only for AD users (- 40.4%). The mean overall follow-up was 4.6 ± 4.1 years. Overall, 523 patients (13.1%) died within 30 days of their AMI. The remainder survived a mean 5.3 ± 4.0 years. After adjusting for potential confounders, use of antidepressants was independently associated with mortality (adj OR = 1.75, 95% CI: 1.40-2.19). CONCLUSIONS Our findings show that AD users hospitalized for AMI have a worse prognosis in terms of mortality. The use of routinely-available records can prove an efficient way to monitor trends in the state of health of specific subpopulations, enabling the early identification of AMI survivors with a history of antidepressant use.
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Affiliation(s)
- Silvia Cocchio
- 0000 0004 1757 3470grid.5608.bDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121 Padova, Italy
| | - Tatjana Baldovin
- 0000 0004 1757 3470grid.5608.bDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121 Padova, Italy
| | - Patrizia Furlan
- 0000 0004 1757 3470grid.5608.bDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121 Padova, Italy
| | - Alessandra Buja
- 0000 0004 1757 3470grid.5608.bDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121 Padova, Italy
| | | | - Marco Fonzo
- 0000 0004 1757 3470grid.5608.bDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121 Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121, Padova, Italy.
| | - Chiara Bertoncello
- 0000 0004 1757 3470grid.5608.bDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121 Padova, Italy
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16
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Parker GB, Cvejic E, Vollmer-Conna U, McCraw S, Granville Smith I, Walsh WF. Depression and poor outcome after an acute coronary event: Clarification of risk periods and mechanisms. Aust N Z J Psychiatry 2019; 53:148-157. [PMID: 29565178 DOI: 10.1177/0004867418763730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Lifetime depression and depression around the time of an acute coronary syndrome event have been associated with poor cardiac outcomes. Our study sought to examine the persistence of this association, especially given modern cardiac medicine's successes. METHODS For 332 patients admitted for an acute coronary syndrome, a baseline interview assessed major depression status, and psychological measures were administered. At 1 and 12 months post-acute coronary syndrome event, telephone interviews collected rates of hospital readmission and/or death and major depression status, while biomarker information was examined using medical records. RESULTS The 12-month mortality rate was 2.3% and cardiac readmission rate 21.0%. Depression subsequent to an acute coronary syndrome event resulted in a threefold and 2.5-fold increase in 1-month and 12-month odds of cardiac readmission or death, respectively. No relationship with past depressive episodes was found. Poor sleep was associated with higher trait anxiety and neuroticism scores and with more severe depression. CONCLUSION Lifetime depression may increase the risk of depression around the time of an acute coronary syndrome but not influence cardiac outcomes. We suggest that poor sleep quality may be causal or indicate high anxiety/neuroticism, which increases risk to depression and contributes to poor cardiac outcomes rather than depression being the primary causal factor.
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Affiliation(s)
- Gordon B Parker
- 1 School of Psychiatry, University of New South Wales Sydney, Sydney, NSW, Australia.,2 Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Erin Cvejic
- 1 School of Psychiatry, University of New South Wales Sydney, Sydney, NSW, Australia.,3 School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Ute Vollmer-Conna
- 1 School of Psychiatry, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Stacey McCraw
- 1 School of Psychiatry, University of New South Wales Sydney, Sydney, NSW, Australia.,2 Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | | | - Warren F Walsh
- 4 Prince of Wales Hospital, Cardiology Department, Sydney, NSW, Australia
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17
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Ludwig VM, Bayley A, Cook DG, Stahl D, Treasure JL, Asthworth M, Greenough A, Winkley K, Bornstein SR, Ismail K. Association between depressive symptoms and objectively measured daily step count in individuals at high risk of cardiovascular disease in South London, UK: a cross-sectional study. BMJ Open 2018; 8:e020942. [PMID: 29654044 PMCID: PMC5898324 DOI: 10.1136/bmjopen-2017-020942] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Depressive symptoms are common but rarely considered a risk factor for unhealthy lifestyles associated with cardiovascular disease (CVD). This study investigates whether depressive symptoms are associated with reduced physical activity (PA) in individuals at high risk of developing CVD. DESIGN Secondary analysis of the cross-sectional baseline data from a randomised controlled trial of an intensive lifestyle intervention. SETTING 135 primary care practices in South London, UK. PARTICIPANTS 1742 adults, 49-74 years, 86% male at high (≥20%) risk of developing CVD in the next 10 years as defined via QRISK2 score. OUTCOME MEASURES The main explanatory variable was depressive symptoms measured via the Patient Health Questionnaire-9 (PHQ-9). The main outcome was daily step count measured with an accelerometer (ActiGraph GT3X) stratified by weekdays and weekend days. RESULTS The median daily step count of the total sample was 6151 (IQR 3510) with significant differences (P<0.001) in mean daily step count between participants with low (PHQ-9 score: 0-4), mild (PHQ-9 score: 5-9) and moderate to severe depressive symptoms (PHQ-9 score: ≥10). Controlling for age, gender, ethnicity, education level, body mass index (BMI), smoking, consumption of alcohol, day of the week and season, individuals with mild depressive symptoms and those with moderate to severe depressive symptoms walked 13.3% (95% CI 18.8% to 7.9%) and 15.6% (95% CI 23.7% to 6.5%) less than non-depressed individuals, respectively. Furthermore, male gender, white ethnicity, higher education level, lower BMI, non-smoking, moderate alcohol intake, weekdays and summer season were independently associated with higher step count. CONCLUSIONS People at high risk of CVD with depressive symptoms have lower levels of PA. TRIAL REGISTRATION ISRCTN84864870; Pre-results.
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Affiliation(s)
- Vera M Ludwig
- Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Adam Bayley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, London, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Janet L Treasure
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Asthworth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Anne Greenough
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Kirsty Winkley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stefan R Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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18
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Yang L, Korhonen K, Moustgaard H, Silventoinen K, Martikainen P. Pre-existing depression predicts survival in cardiovascular disease and cancer. J Epidemiol Community Health 2018; 72:617-622. [DOI: 10.1136/jech-2017-210206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/23/2018] [Accepted: 02/09/2018] [Indexed: 12/18/2022]
Abstract
BackgroundPrevious studies have found depression to be negatively associated with the prognosis of both cardiovascular disease (CVD) and cancer, but this may partly reflect reverse causality. We limited the possibility of reverse causality by measuring depression before the first diagnosis of CVD or cancer.MethodsWe used an 11% longitudinal random sample of the Finnish population aged 25 years or older who are residents of Finland for at least 1 year between 1987 and 2007, with an 80% oversample of those who died during this period. Those who had their first incidence of coronary heart disease (CHD) (n=107 966), stroke (n=68 685) or cancer (n=113 754) between 1998 and 2012 were followed up for cause-specific mortality from the date of diagnosis until the end of 2012. Depression was defined as having antidepressant purchases two to three calendar years before the incidence. Logistic and Cox regression models were used to examine short-term and long-term mortality by depression status.ResultsLong-term mortality after diagnosis was 1.34 (95% CI 1.25 to 1.44) for CHD, 1.26 (95% CI 1.15 to 1.37) for stroke and 1.10 (95% CI 1.04 to 1.16) for cancer in those who had used antidepressants in two consecutive calendar years as compared with those with no purchases. Short-term mortality from CHD was elevated among persons with depression (OR=1.30; 95% CI 1.06 to 1.61), but no association was found for stroke.ConclusionPre-existing depression is associated with a worse prognosis of CHD, stroke and cancer. More attention in the healthcare system is needed for patients with chronic diseases who have a history of depression.
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