title: Depression Treatment and 1-Year Mortality After Acute Myocardial Infarction: Insights From the TRIUMPH Registry (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status).
abstract: BACKGROUND
  Depression among patients with acute myocardial infarction (AMI) is prevalent and associated with an adverse quality of life and prognosis. Despite recommendations from some national organizations to screen for depression, it is unclear whether treatment of depression in patients with AMI is associated with better outcomes. We aimed to determine whether the prognosis of patients with treated versus untreated depression differs.
  
  
  METHODS
  The TRIUMPH study (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status) is an observational multicenter cohort study that enrolled 4062 patients aged ≥18 years with AMI between April 11, 2005, and December 31, 2008, from 24 US hospitals. Research coordinators administered the Patient Health Questionnaire-9 (PHQ-9) during the index AMI admission. Depression was defined by a PHQ-9 score of ≥10. Depression was categorized as treated if there was documentation of a discharge diagnosis, medication prescribed for depression, or referral for counseling, and as untreated if none of these 3 criteria was documented in the medical records despite a PHQ score ≥10. One-year mortality was compared between patients with AMI having: (1) no depression (PHQ-9<10; reference); (2) treated depression; and (3) untreated depression adjusting for demographics, AMI severity, and clinical factors.
  
  
  RESULTS
  Overall, 759 (18.7%) patients met PHQ-9 criteria for depression and 231 (30.4%) were treated. In comparison with 3303 patients without depression, the 231 patients with treated depression had 1-year mortality rates that were not different (6.1% versus 6.7%; adjusted hazard ratio, 1.12; 95% confidence interval, 0.63-1.99). In contrast, the 528 patients with untreated depression had higher 1-year mortality in comparison with patients without depression (10.8% versus 6.1%; adjusted hazard ratio, 1.91; 95% confidence interval, 1.39-2.62).
  
  
  CONCLUSIONS
  Although depression in patients with AMI is associated with increased long-term mortality, this association may be confined to patients with untreated depression.
authors.affiliation: From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.). smolderenk@umkc.edu.
authors.forename: Kim G
authors.initials: KG
authors.lastname: Smolderen
authors.affiliation: From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.).
authors.forename: Donna M
authors.initials: DM
authors.lastname: Buchanan
authors.affiliation: From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.).
authors.forename: Kensey
authors.initials: K
authors.lastname: Gosch
authors.affiliation: From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.).
authors.forename: Mary
authors.initials: M
authors.lastname: Whooley
authors.affiliation: From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.).
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
authors.affiliation: From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.).
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.affiliation: From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.).
authors.forename: Susmita
authors.initials: S
authors.lastname: Parashar
authors.affiliation: From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.).
authors.forename: Amit J
authors.initials: AJ
authors.lastname: Shah
authors.affiliation: From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.).
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.).
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002423:Cause of Death; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents
keywords: depression; mortality; myocardial infarction; survival