Depression Treatment and 1-Year Mortality Following Acute Myocardial Infarction: Insights from the TRIUMPH Registry
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 prognosis of patients with treated vs. untreated depression differs.
Methods—The TRIUMPH study is an observational multi-center cohort study that enrolled 4,062 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 three criteria were 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. Compared with 3303 patients without depression, the 231 patients with treated depression had 1-year mortality rates that were not different (6.1% vs. 6.7%, adjusted HR=1.12, 95% CI: 0.63-1.99). In contrast, the 528 patients with untreated depression had higher 1-year mortality when compared with patients without depression (10.8% vs. 6.1%, adjusted HR=1.91, 95%CI 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 and untreated depression.
- Received August 22, 2016.
- Revision received January 18, 2017.
- Accepted February 10, 2017.