title: Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study.
abstract: Depressive symptoms are prevalent in patients with coronary artery disease (CAD). It is unclear, however, how depressive symptoms change over time and the impact of these changes on long-term functional outcomes. We examined the association between different trajectories of depressive symptoms over 1 year and change in functional status over 30 months among patients undergoing coronary angiography.
  
  
  
  This was a prospective cohort study of 350 patients aged 60 and older undergoing non-emergent cardiac catheterization (October 2003-February 2007). A dynamic measure of significant depressive symptoms (i.e., Geriatric Depression Scale score 5+) capturing change over 12 months was derived that categorized patients into the following groups: (i) no clinically important depressive symptoms (at baseline, 6 and 12 months); (ii) baseline-only symptoms (at baseline but not at 6 and 12 months); (iii) new onset symptoms (not at baseline but present at either 6 or 12 months); and, (iv) persistent symptoms (at baseline and at either 6 or 12 month assessment). Primary outcomes were mean change in Older Americans Resources and Services (OARS) instrumental (IADL) and basic activities of daily living (BADL) scores (range 0-14 for each) across baseline (pre-procedure) and 6, 12, and 30 months post-procedure visits.
  
  
  
  Estimates for the symptom categories were 71 % (none), 9 % (baseline only), 8 % (new onset) and 12 % (persistent). In adjusted models, patients with persistent symptoms showed a significant decrease in mean IADL and BADL scores from baseline to 6 months (-1.32 [95 % CI -1.78 to -0.86] and -0.63 [-0.97 to -0.30], respectively) and from 12 to 30 months (-0.79 [-1.27 to -0.31] and -1.00 [-1.35 to -0.65], respectively). New onset symptoms were associated with a significant decrease in mean IADL scores at 6 months and from 6 to 12 months. Patients with no depressive symptoms showed little change in scores whereas those with baseline only symptoms showed significant improvement in mean IADL at 6 months.
  
  
  
  Patients with persistent depressive symptoms were at greatest risk for worse functional status 30 months following coronary interventions. Proactive screening and follow-up for depression in this population offers prognostic value and may facilitate the implementation of targeted interventions.
authors: Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada.|Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
authors: M Elizabeth
authors: ME
authors: Wilcox
authors: Institute of Social Research, University of Michigan, Ann Arbor, USA.
authors: Elizabeth A
authors: EA
authors: Freiheit
authors: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.|Research, Innovation and Analytics, Alberta Health Services, Foothills Medical Centre, Calgary, Canada.
authors: Peter
authors: P
authors: Faris
authors: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.|Department of Medicine (Division of Geriatric Medicine), Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors: David B
authors: DB
authors: Hogan
authors: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.|Department of Psychiatry and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors: Scott B
authors: SB
authors: Patten
authors: Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.|Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.|Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada.
authors: Todd
authors: T
authors: Anderson
authors: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.|Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.|Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada.
authors: William A
authors: WA
authors: Ghali
authors: Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.|Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.|Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada.
authors: Merril
authors: M
authors: Knudtson
authors: Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors: Andrew
authors: A
authors: Demchuk
authors: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada. colleen.maxwell@uwaterloo.ca.|Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, N2L 3G1, ON, Canada. colleen.maxwell@uwaterloo.ca.|Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada. colleen.maxwell@uwaterloo.ca.
authors: Colleen J
authors: CJ
authors: Maxwell
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000523:psychology* / Q000628:therapy; D003863:Depression / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D057187:Independent Living / Q000523:psychology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*
keywords: Cohort study; Coronary artery disease; Coronary intervention; Depression; Functional decline; Functional outcomes