Abstract 17031: Initiation of β-Blocker Therapy and Depression Risk After Myocardial Infarction
Introduction: While β-blockers reduce mortality after acute myocardial infarction (AMI), physicians are often concerned that their use may exacerbate symptoms of depression. We examined the association of β-blocker initiation with change in depressive symptoms in patients with AMI.
Methods: Using data from 2 US multi-center, prospective registries of AMI patients (PREMIER and TRIUMPH), we examined change in depressive symptoms between the index hospitalization and 1 month later among 2891 patients who were β-blocker naïve on admission, using the validated 8-item Patient Health Questionnaire (PHQ-8). The PHQ rates depressive symptoms from 0 to 24, where higher scores indicate more depressive symptoms. We compared patients who were initiated on a β-blocker to those who were not. We also examined whether 1-month change in depressive symptoms were different between the β-blocker groups using an optimally matched propensity score analysis (C-statistic=0.81), which incorporated 33 relevant clinical, socioeconomic and psychosocial variables including discharge heart rate and blood pressure, COPD, baseline PHQ-8 score and antidepressant treatment.
Results: There were 2666 (92.2%) patients who were initiated on a β-blocker after AMI and 225 (7.8%) who were not. Patients initiated on a β-blocker were more likely to be younger, male, or to have presented with an ST-elevation AMI but had fewer comorbidities (all P<0.03). Baseline PHQ-8 scores were similar between the 2 groups: β-blocker group, 4.8 vs. no β-blocker group, 5.4, P=0.09. At 1-month, PHQ-8 scores decreased by a mean of 0.86 in the β-blocker group (p<0.0001) vs. 0.64 in the no β-blocker group (P=0.05). After propensity matching of 201 patients not on β-blocker therapy with 570 patients initiated on a β-blocker, initiation of β-blocker therapy was not associated with a difference in mean 1-month change in PHQ-8 scores compared to untreated patients (absolute mean difference with β-blocker initiation, -0.33, 95% CI -1.16 to 0.50, P=0.43).
Conclusions: Initiation of β-blocker therapy after AMI was not associated with an increase in depressive symptoms at 1-month follow-up. Restricted use of β-blockers because of concerns about depression may be unwarranted and may lead to under-treatment of AMI patients.
- © 2010 by American Heart Association, Inc.