Depressed patients who have a coronary stent implanted have nearly double the risk of death than non-depressed patients.
Depression has been linked to poor outcomes in coronary artery disease. However, prior research has primarily focused on short-term effects, mostly in patients who have had a myocardial infarction or a coronary bypass operation.
Researchers investigated the impact of depression on death during a seven-year followup period in patients treated with percutaneous coronary intervention (PCI).
For the study, 1,234 PCI patients between the ages of 26-90 years (average age 62) from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital registry filled out the Hospital Anxiety and Depression Scale to keep track of depression six months after having a stent implant.
The study’s primary measure was the total number of patient deaths observed at the end of the study.
Of all the patients, about 26 percent were depressed. After seven years there were 187 deaths in total — or about 15 percent of the patients who enrolled in the study. The prevalence of deaths in depressed patients was 23.5 percent — nearly double the amount of non-depressed patient deaths of 12.2 percent.
Depression was independently associated with patient deaths after adjusting for socio-demographics (age, gender), clinical characteristics, anxiety and a distressed personality.
Clinical characteristics included type of stent, number of vessels obstructed, body mass index, past cardiac surgery or myocardial infarction, indication for the PCI procedure, coronary risk factors and cardiac medications.
Male gender, older age, and diabetes mellitus were also significantly tied to an increased risk of death after seven years of followup, whereas statins were associated with a reduced risk. Anxiety and a distressed personality had no significant effect on the rate of patient deaths.
“The main finding is that patients who are depressed after coronary stenting have a worse prognosis,” says lead author Nikki Damen, a PhD student at Tilburg University in the Netherlands.
“They die earlier than non-depressed patients.”
The reasons for the results are still being studied.
One possible explanation is that perhaps depressed patients have less healthy lifestyles with regard to smoking, drinking alcohol, physical activity, and diet, and may be less diligent in taking medication. Another possible explanation is that depression could affect the sympathetic nervous system, leading to increases in heart rate and blood pressure.
“Doctors and nurses have traditionally focussed on medical factors like diabetes or family history of cardiovascular disease when assessing PCI patients’ risk of death, but that’s not the whole picture,” says Damen. “Psychological factors do matter as well, in combination with the medical factors.”
“More research is needed to determine how to screen for depression in cardiovascular patients, and then how to provide treatment,” she adds.
The research was presented at the 12th Annual Spring Meeting on Cardiovascular Nursing in Copenhagen, Denmark.
Source: European Society of Cardiology