Anaemia and the development of depressive symptoms following acute coronary syndrome: longitudinal clinical observational study.
OBJECTIVE
Depressive symptoms are common following acute coronary syndrome (ACS) and predict subsequent cardiovascular morbidity. Depression in acute cardiac patients appears to be independent of clinical disease severity and other cardiovascular measures. One factor that has not been considered previously is anaemia, which is associated with fatigue and adverse cardiac outcomes. This study assessed the relationship between anaemia on admission and depressive symptoms following ACS.


METHODS
Longitudinal clinical observational study.


METHODS
Coronary care unit.


METHODS
223 patients with documented ACS.


METHODS
Depressive symptoms measured with the Beck Depression Inventory 3 weeks after admission.


RESULTS
Anaemia was defined with WHO criteria and was present in 30 (13.5%) patients. Anaemia predicted raised depression scores 3 weeks later independently of age, gender, marital status, educational attainment, smoking, Global Registry of Acute Cardiac Events (GRACE) risk scores, negative mood in hospital and history of depression (p=0.003). The odds of a Beck Depression Inventory score ≥10 among anaemic patients were 4.03 (95% CIs 1.48 to 11.00), adjusted for covariates. Sensitivity analyses indicated that effects were also present when haemoglobin was analysed as a continuous measure. Anaemia also predicted major adverse cardiac events over the subsequent 12 months.


CONCLUSIONS
Anaemia appears to contribute to depression following ACS and is associated with future cardiac morbidity. Studies evaluating the effects of anaemia management will help delineate the role of this pathway more precisely.
Department of Epidemiology and Public Health, University College London, London, UK.
Andrew
A
Steptoe
Anna
A
Wikman
Gerard J
GJ
Molloy
Juan-Carlos
JC
Kaski