title: Pre-existent depression in the 2 weeks before an acute coronary syndrome can be associated with delayed presentation of the heart attack.
abstract: BACKGROUND
  Depression is common among patients with acute coronary syndrome (ACS).
  
  
  OBJECTIVE
  To examine how depression may alter outcome of ACS.
  
  
  METHODS
  Observational study on how ongoing depression influences the time delay to seeking help and its effects on subsequent treatment compliance after discharge.
  
  
  METHODS
  Depression was measured by Beck Depression Inventory (BDI) 2 weeks prior to presentation on consecutive patients with ACS.
  
  
  RESULTS
  Of the 276 patients, 81 had BDI > or =10 and 195 had BDI score <10. The time from onset of the predominant symptom to seeking help tended to be longer in those with BDI > or =10 than in those with BDI <10 [180 (IQR 37.5-1042.5) min vs. 120 (IQR 30-735) min, P = 0.099]. Results were similar for the 68 with ST elevation myocardial infarction (MI) [238 (IQR 49-709) min vs. 60 (IQR 20-352) min, P = 0.071]. Each point increase of BDI predicted an approximately 4.2% [95% confidence interval (CI) 0.4-8.0%] increase in the time duration, P = 0.029. On multivariable analysis, the effect of BDI persisted (6.0% increase in duration per each point increase in BDI, 95% CI 2.4-9.7%, P = 0.001). Among the 68 patients who had ST elevation MI, results were similar with an 8.0% (95%CI 1.7-14.7%, P = 0.013) increase in time duration for each unit increase in BDI. Results were also similar when BDI was evaluated as a dichotomous variable. Small differences were observed for subsequent treatment compliance.
  
  
  CONCLUSIONS
  Ongoing depression delays the presentation of ACS.
authors.affiliation: Department of Cardiology, Dunedin School of Medicine, University of Otago, Dunedin Public Hospital, New Zealand. cheuk-kit.wong@healthotago.co.nz
authors.forename: C-K
authors.initials: CK
authors.lastname: Wong
authors.forename: E W
authors.initials: EW
authors.lastname: Tang
authors.forename: P
authors.initials: P
authors.lastname: Herbison
authors.forename: B
authors.initials: B
authors.lastname: Birmingham
authors.forename: L
authors.initials: L
authors.lastname: Barclay
authors.forename: S Y F
authors.initials: SY
authors.lastname: Fu
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology*; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D013997:Time Factors