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Depression and self‐reported functional status: impact on mortality following acute myocardial infarction
Author(s) -
Kurdyak Paul A.,
Chong Alice,
Gnam William H.,
Goering Paula,
Alter David A.
Publication year - 2011
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2010.01446.x
Subject(s) - medicine , myocardial infarction , depression (economics) , hazard ratio , prospective cohort study , mortality rate , cohort study , cardiology , confidence interval , economics , macroeconomics
Objective The cause of increased post‐AMI (acute myocardial infarction) mortality associated with depression remains poorly elucidated. The objective of this study was to examine the extent to which self‐reported cardiac functional status accounted for depression–mortality associations following AMI. Methods Using a prospective cohort design ( n = 1941), the authors obtained self‐reported measures of depression and developed profiles of the patients' pre‐hospitalization cardiac risks, co‐morbid conditions and drugs and revascularization procedures during or following index AMI hospitalization. To create these profiles, the patients' self‐reports were retrospectively linked to no less than 12 years' worth of previous hospitalization data. Mortality rates 2 years after acute MI were examined with and without sequential risk adjustment for age, sex, income, cardiovascular risk, co‐morbid conditions, selected process‐of‐care factors and self‐reported cardiac functional status. Results Depression was strongly correlated with 2‐year mortality rate [crude hazard ratio (HR) of severe vs. minimal depression category, 2.48 (95% CI 1.20–5.15); P = 0.01]. However, after sequential adjustment for age, sex, income and self‐reported cardiac functional status, the effect of depression was greatly attenuated [adjusted HR for severe vs. minimal depression category, 1.35 (95% CI 0.63–2.87); P = 0.44]. Cardiac risk factors and non‐cardiac co‐morbidities had negligible explanatory effect. Discussion The main factor determining the increased mortality rate in depressed patients is self‐reported cardiac functional status. Efforts to address increased mortality in depressed patients with cardiovascular illnesses should focus on processes that impact cardiac functional status.