Abstract 17184: Depression Recognition and 1-Year Survival in Acute Myocardial Infarction Patients
Background: Depression among acute myocardial infarction (AMI) patients is prevalent and associated with an adverse prognosis. Although depression often remains undetected in AMI patients, there is still debate about the importance of screening for depression at the time of AMI. Defining the prognostic importance of unrecognized depression may support better efforts to increase its recognition.
Methods: In the prospective TRIUMPH study, 4062 AMI patients from 24 US hospitals completed the Patient Health Questionnaire-9 (PHQ-9) during their index AMI admission. Depression was defined by a PHQ-9 score of ≥10. Depression was considered to be recognized by the treating team if it was documented in the patient's chart (discharge depression diagnosis, discharge anti-depressants, referrals for counseling). Follow-up interview data on use of anti-depressants and/or counseling was collected at 1 and 6 months. One-year mortality was compared between: (1) recognized depressed; (2) unrecognized depressed; and (3) non-depressed (PHQ-9<10; reference) patients, adjusting for demographics, AMI severity, and clinical factors. Sensitivity analysis additionally adjusted for follow-up depression treatment.
Results: Although 759 (19%) patients were depressed, only 231 (30%) were recognized. As compared with non-depressed patients, recognized depressed AMI patients had similar 1-year mortality rates (6.7% vs. 6.1%, adjusted HR=1.12, 95%CI 0.63-2.00), whereas those with unrecognized depression had increased mortality (10.8% vs. 6.1%, HR=1.92, 95%CI 1.39-2.64). Recognized vs. unrecognized depressed patients received more depression treatment after discharge (70% vs. 24%), but this did not attenuate the increased hazard for the unrecognized patients.
Conclusion: AMI patients with recognized depression had similar survival compared with non-depressed patients, but patients with unrecognized depression had worse survival. These findings raise the possibility that recognizing depression during AMI care may be crucial to better risk-stratify depressed AMI patients so that more aggressive cardiac treatments can be considered to reduce their elevated mortality risk.
- © 2011 by American Heart Association, Inc.