Transient impact of baseline depression on mortality in patients with stable coronary heart disease during long-term follow-up.
OBJECTIVE
The objective of this prospective study was to determine the impact of depressive symptoms on long-term survival in coronary heart disease (CHD) patients treated with intracoronary stenting.


METHODS
Four hundred and seventy patients completed the Hospital Anxiety and Depression Scale (HADS) before undergoing stent implantation and were followed over a 5-year period. Survival data were collected from n = 462 participants (98.3 %). A cut-off ≥8 on the HADS depression subscale was used to indicate probable clinical levels of depression.


RESULTS
All-cause mortality rates differed significantly between depressed and non-depressed patients at 2-year follow-up, as 6 out of 98 subjects with elevated HADS-D scores (6.1 %), but only 8 out of 364 (2.2 %) patients with normal HADS-D scores had died [odds ratio = 2.9, 95 % confidence interval (95 % CI) = 1.0-8.6, p = 0.044]. In a Cox regression model adjusted for sociodemographic and clinical parameters, positive HADS-D scores [hazard ratio (HR) = 4.3, 95 % CI = 1.2-15.4, p = 0.025], body-mass index (HR = 0.8, 95 % CI = 0.7-1.0, p = 0.040) and stent length (HR = 1.1, 95 % CI = 1.0-1.1, p = 0.042) independently predicted 2-year survival. From the third to the fifth year after index PCI, the frequency of deaths in the depressed patients' group did not significantly differ from that observed in non-depressed patients (5.5 % versus 7.0 %, p = 0.607), and the predictive role of baseline HADS-D scores for survival was lost.


CONCLUSIONS
In CHD patients, self-rated depressive symptoms at baseline were negatively linked to survival at 2-year follow-up, but failed to predict mortality 3 years later. Thus, in contrast to other well-established risk factors, the prognostic value of depression for predicting adverse outcome may be temporarily limited. The mechanisms behind this transient effect need further study.
Klinik für Psychosomatische Medizin und Psychotherapie, Deutsches Zentrum für Herz- und Kreislaufforschung, Universität Göttingen, von-Siebold-Str. 5, 37075, Göttingen, Germany, thomas.meyer@med.uni-goettingen.de.
Thomas
T
Meyer
Sharif
S
Hussein
Helmut W
HW
Lange
Christoph
C
Herrmann-Lingen
D000368:Aged; D060050:Angina, Stable / Q000000981:diagnostic imaging / Q000401:mortality / Q000523:psychology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D016022:Case-Control Studies; D002423:Cause of Death; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000523:psychology* / Q000628:therapy; D003863:Depression / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D057566:Self Report; D012720:Severity of Illness Index; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors