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(Circulation. 1995;91:999-1005.)
© 1995 American Heart Association, Inc.
Articles |
Depression and 18-Month Prognosis After Myocardial Infarction
From the Research Center (N.F.-S., F.L., M.T.), Montreal Heart Institute, Montreal; Department of Psychiatry (N.F.-S., F.L.), McGill University, Montreal; and Departments of Psychiatry (N.F.-S., F.L.) and Medicine (M.T.), University of Montreal, Montreal, Canada.
Correspondence to Dr Nancy Frasure-Smith, Research Center, Montreal Heart Institute, 5000 Belanger St E, Montreal, Quebec, Canada H1T 1C8.
Background We previously reported that major depression in patients in the hospital after a myocardial infarction (MI) substantially increases the risk of mortality during the first 6 months. We examined the impact of depression over 18 months and present additional evidence concerning potential mechanisms linking depression and mortality.
Methods and Results Two-hundred twenty-two patients responded to
a modified version of the National Institute of Mental Health
Diagnostic Interview Schedule (DIS) for a major depressive episode at
approximately 7 days after MI. The Beck Depression Inventory (BDI),
which measures depressive symptomatology, was also completed by 218 of
the patients. All patients and/or families were contacted at 18 months
to determine survival status. Thirty-five patients met the modified DIS
criteria for major in-hospital depression after the MI. Sixty-eight had
BDI scores 
10, indicative of mild to moderate symptoms of depression.
There were 21 deaths during the follow-up period, including 19 from
cardiac causes. Seven of these deaths occurred among patients who met
DIS criteria for depression, and 12 occurred among patients with
elevated BDI scores. Multiple logistic regression analyses showed that
both the DIS (odds ratio, 3.64; 95% confidence interval [CI], 1.32
to 10.05; P=.012) and elevated BDI scores (odds ratio, 7.82;
95% CI, 2.42 to 25.26; P=.0002) were significantly related
to 18-month cardiac mortality. After we controlled for the other
significant multivariate predictors of mortality in the data set
(previous MI, Killip class, premature ventricular contractions
[PVCs]
of 10 per hour), the impact of the BDI score remained significant
(adjusted odds ratio, 6.64; 95% CI, 1.76 to 25.09;
P=.0026). In addition, the interaction of PVCs and BDI score
marginally improved the model (P=.094). The interaction
showed that deaths were concentrated among depressed patients with PVCs
of 10 per hour (odds ratio, 29.1; 95% CI, 6.97 to 122.07;
P<.00001).
Conclusions Depression while in the hospital after an MI is a
significant predictor of 18-month post-MI cardiac mortality. Depression
also significantly improves a risk-stratification model based on
traditional post-MI risks, including previous MI, Killip class, and
PVCs. Furthermore, the risk associated with depression is greatest
among patients with 10 PVCs per hour. This result is compatible with
the literature suggesting an arrhythmic mechanism as the link between
psychological factors and sudden cardiac death and underscores the
importance of developing screening and treatment programs for post-MI
depression.
Key Words: myocardial infarction • depression • arrhythmias • prognosis
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J. A. Fauerbach, D. E. Bush, B. D. Thombs, U. D. McCann, J. Fogel, and R. C. Ziegelstein Depression Following Acute Myocardial Infarction: A Prospective Relationship With Ongoing Health and Function Psychosomatics, August 1, 2005; 46(4): 355 - 361. [Abstract] [Full Text] [PDF]
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J. H.K. Vogel, S. F. Bolling, R. B. Costello, E. M. Guarneri, M. W. Krucoff, J. C. Longhurst, B. Olshansky, K. R. Pelletier, C. M. Tracy, R. A. Vogel, et al. Integrating Complementary Medicine Into Cardiovascular Medicine: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (Writing Committee to Develop an Expert Consensus Document on Complementary and Integrative Medicine) J. Am. Coll. Cardiol., July 5, 2005; 46(1): 184 - 221. [Full Text] [PDF]
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 L. V. Doering, D. K. Moser, W. Lemankiewicz, C. Luper, and S. Khan Depression, Healing, and Recovery From Coronary Artery Bypass Surgery Am. J. Crit. Care., July 1, 2005; 14(4): 316 - 324. [Abstract] [Full Text] [PDF]
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S. C. Matthews, R. A. Nelesen, and J. E. Dimsdale Depressive Symptoms Are Associated With Increased Systemic Vascular Resistance to Stress Psychosom Med, July 1, 2005; 67(4): 509 - 513. [Abstract] [Full Text] [PDF]
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K. Z. Bambauer, O. Aupont, P. H. Stone, S. E. Locke, M. G. Mullan, J. Colagiovanni, and T. J. McLaughlin The Effect of a Telephone Counseling Intervention on Self-Rated Health of Cardiac Patients Psychosom Med, July 1, 2005; 67(4): 539 - 545. [Abstract] [Full Text] [PDF]
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P. K. Agatisa, K. A. Matthews, J. T. Bromberger, D. Edmundowicz, Y.-F. Chang, and K. Sutton-Tyrrell Coronary and Aortic Calcification in Women With a History of Major Depression Arch Intern Med, June 13, 2005; 165(11): 1229 - 1236. [Abstract] [Full Text] [PDF]
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R. C. Ziegelstein, S. Y. Kim, D. Kao, J. A. Fauerbach, B. D. Thombs, U. McCann, J. Colburn, and D. E. Bush Can Doctors and Nurses Recognize Depression in Patients Hospitalized With an Acute Myocardial Infarction in the Absence of Formal Screening? Psychosom Med, May 1, 2005; 67(3): 393 - 397. [Abstract] [Full Text] [PDF]
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T. Z. Naqvi, S. S.A. Naqvi, and C. N. B. Merz Gender Differences in the Link Between Depression and Cardiovascular Disease Psychosom Med, May 1, 2005; 67(Supplement_1): S15 - S18. [Abstract] [Full Text] [PDF]
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N. Frasure-Smith and F. Lesperance Reflections on Depression as a Cardiac Risk Factor Psychosom Med, May 1, 2005; 67(Supplement_1): S19 - S25. [Abstract] [Full Text] [PDF]
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R. M. Carney, K. E. Freedland, and R. C. Veith Depression, the Autonomic Nervous System, and Coronary Heart Disease Psychosom Med, May 1, 2005; 67(Supplement_1): S29 - S33. [Abstract] [Full Text] [PDF]
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J. A. Blumenthal, A. Sherwood, M. A. Babyak, L. L. Watkins, R. Waugh, A. Georgiades, S. L. Bacon, J. Hayano, R. E. Coleman, and A. Hinderliter Effects of Exercise and Stress Management Training on Markers of Cardiovascular Risk in Patients With Ischemic Heart Disease: A Randomized Controlled Trial JAMA, April 6, 2005; 293(13): 1626 - 1634. [Abstract] [Full Text] [PDF]
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W. Whang, C. M. Albert, S. F. Sears Jr, R. Lampert, J. B. Conti, P. J. Wang, J. P. Singh, J. N. Ruskin, J. E. Muller, M. A. Mittleman, et al. Depression as a predictor for appropriate shocks among patients with implantable cardioverter-defibrillators: Results from the Triggers of Ventricular Arrhythmias (TOVA) study J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1090 - 1095. [Abstract] [Full Text] [PDF]
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 J. K. Schulman, P. R. Muskin, and P. A. Shapiro Psychiatry and Cardiovascular Disease Focus, April 1, 2005; 3(2): 208 - 224. [Abstract] [Full Text] [PDF]
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S. Mallik, H. M. Krumholz, Z. Q. Lin, S. V. Kasl, J. A. Mattera, S. A. Roumains, and V. Vaccarino Patients With Depressive Symptoms Have Lower Health Status Benefits After Coronary Artery Bypass Surgery Circulation, January 25, 2005; 111(3): 271 - 277. [Abstract] [Full Text] [PDF]
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A. A. Nierenberg, P. Eidelman, Y. Wu, and M. Joseph Depression: An Update for the Clinician Focus, January 1, 2005; 3(1): 3 - 12. [Full Text] [PDF]
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 C. Marzari, S. Maggi, E. Manzato, C. Destro, M. Noale, D. Bianchi, N. Minicuci, G. Farchi, M. Baldereschi, A. Di Carlo, et al. Depressive Symptoms and Development of Coronary Heart Disease Events: The Italian Longitudinal Study on Aging J. Gerontol. A Biol. Sci. Med. Sci., January 1, 2005; 60(1): 85 - 92. [Abstract] [Full Text] [PDF]
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 S U Shah, A White, S White, and W A Littler Heart and mind: (1) relationship between cardiovascular and psychiatric conditions Postgrad. Med. J., December 1, 2004; 80(950): 683 - 689. [Abstract] [Full Text] [PDF]
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S. P. Roose, H. A. Sackeim, K. R. R. Krishnan, B. G. Pollock, G. Alexopoulos, H. Lavretsky, I. R. Katz, H. Hakkarainen, and Old-Old Depression Study Group Antidepressant Pharmacotherapy in the Treatment of Depression in the Very Old: A Randomized, Placebo-Controlled Trial Am J Psychiatry, November 1, 2004; 161(11): 2050 - 2059. [Abstract] [Full Text] [PDF]
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J. Barth, M. Schumacher, and C. Herrmann-Lingen Depression as a Risk Factor for Mortality in Patients With Coronary Heart Disease: A Meta-analysis Psychosom Med, November 1, 2004; 66(6): 802 - 813. [Abstract] [Full Text] [PDF]
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J. P. van Melle, P. de Jonge, T. A. Spijkerman, J. G. P. Tijssen, J. Ormel, D. J. van Veldhuisen, R. H. S. van den Brink, and M. P. van den Berg Prognostic Association of Depression Following Myocardial Infarction With Mortality and Cardiovascular Events: A Meta-analysis Psychosom Med, November 1, 2004; 66(6): 814 - 822. [Abstract] [Full Text] [PDF]
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N. J. S. Christenfeld, R. P. Sloan, D. Carroll, and S. Greenland Risk Factors, Confounding, and the Illusion of Statistical Control Psychosom Med, November 1, 2004; 66(6): 868 - 875. [Abstract] [Full Text] [PDF]
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M. M. Burg, R. Lampert, T. Joska, W. Batsford, and D. Jain Psychological Traits and Emotion-Triggering of ICD Shock-Terminated Arrhythmias Psychosom Med, November 1, 2004; 66(6): 898 - 902. [Abstract] [Full Text] [PDF]
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G.E. Schuitemaker, G.J. Dinant, G.A. v. d. Pol, and A. Appels Assessment of Vital Exhaustion and Identification of Subjects at Increased Risk of Myocardial Infarction in General Practice Psychosomatics, October 1, 2004; 45(5): 414 - 418. [Abstract] [Full Text] [PDF]
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M. Kumari, J. Head, and M. Marmot Prospective Study of Social and Other Risk Factors for Incidence of Type 2 Diabetes in the Whitehall II Study Arch Intern Med, September 27, 2004; 164(17): 1873 - 1880. [Abstract] [Full Text] [PDF]
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B. Bankier, J. L. Januzzi, and A. B. Littman The High Prevalence of Multiple Psychiatric Disorders in Stable Outpatients With Coronary Heart Disease Psychosom Med, September 1, 2004; 66(5): 645 - 650. [Abstract] [Full Text] [PDF]
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E. C. Suarez C-Reactive Protein Is Associated With Psychological Risk Factors of Cardiovascular Disease in Apparently Healthy Adults Psychosom Med, September 1, 2004; 66(5): 684 - 691. [Abstract] [Full Text] [PDF]
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D. Koszycki, S. Lafontaine, N. Frasure-Smith, R. Swenson, and F. Lesperance An Open-Label Trial of Interpersonal Psychotherapy in Depressed Patients With Coronary Disease Psychosomatics, August 1, 2004; 45(4): 319 - 324. [Abstract] [Full Text] [PDF]
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