Circulation. 2002;105:1049-1053
Published online before print February 4, 2002, doi: 10.1161/hc0902.104707
Published online before print February 4, 2002, doi: 10.1161/hc0902.104707
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(Circulation. 2002;105:1049.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Five-Year Risk of Cardiac Mortality in Relation to Initial Severity and One-Year Changes in Depression Symptoms After Myocardial Infarction
From the Departments of Psychiatry (F.L., N.F.S.), University of Montreal and McGill University; the Research Centers, Montreal Heart Institute (F.L., N.F.S., M.T., M.G.B.) and Centre Hospitalier de l’Université de Montréal (F.L., N.F.S.); and Department of Medicine (M.T., M.G.B.), University of Montreal, Canada.
Correspondence to François Lespérance, MD, Research Center, Montreal Heart Institute, 5000 Belanger St E, Montreal, Quebec H1T 1C8, Canada. E-mail francois.lesperance{at}umontreal.ca
Background— Although previous research demonstrated an independent link between depression symptoms and cardiac mortality after myocardial infarction (MI), depression was assessed only once, and a dose-response relationship was not evaluated.
Methods and Results— We administered the Beck Depression Inventory to 896 post-MI patients during admission and at 1 year. Five-year survival was ascertained using Medicare data. We observed a significant long-term dose-response relationship between depression symptoms during hospitalization and cardiac mortality. Results remained significant after control for multiple measures of cardiac disease severity. Although 1-year scores were also linked to cardiac mortality, most of that impact was explained by baseline scores. Improvement in depression symptoms was associated with less cardiac mortality only for patients with mild depression. Patients with higher initial scores had worse long-term prognosis regardless of symptom changes.
Conclusions— The level of depression symptoms during admission for MI is more closely linked to long-term survival than the level at 1 year, particularly in patients with moderate to severe levels of depression, suggesting that the presumed cardiovascular mechanisms linking depression to cardiac mortality may be more or less permanent for them.
Key Words: myocardial infarction • depression • prognosis
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N. Frasure-Smith, F. Lesperance, G. Gravel, A. Masson, M. Juneau, and M. G. Bourassa Long-Term Survival Differences Among Low-Anxious, High-Anxious and Repressive Copers Enrolled in the Montreal Heart Attack Readjustment Trial Psychosom Med, July 1, 2002; 64(4): 571 - 579. [Abstract] [Full Text] [PDF]
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