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Time Course of Depression and Outcome of Myocardial Infarction
Susmita Parashar, MD, MPH, MS;
John S. Rumsfeld, MD, PhD;
John A. Spertus, MD, MPH;
Kimberly J. Reid, MS;
Nanette K. Wenger, MD;
Harlan M. Krumholz, MD, SM;
Alpesh Amin, MD;
William S. Weintraub, MD;
Judith Lichtman, PhD;
Nazeera Dawood, MD, MPH;
Viola Vaccarino, MD, PhD; for the PREMIER Registry Investigators
Arch Intern Med. 2006;166:2035-2043.
Background Depression predicts worse outcomes after myocardial infarction (MI), but whether its time course in the month following MI has prognostic importance is unknown. Our objective was to evaluate the prognostic importance of transient, new, or persistent depression on outcomes at 6 months after MI.
Methods In a prospective registry of acute MI (Prospective Registry Evaluating outcomes after Myocardial Infarction: Events and Recovery [PREMIER]), depressive symptoms were measured in 1873 patients with the Patient Health Questionnaire (PHQ) during hospitalization and 1 month after discharge and were classified as transient (only at baseline), new (only at 1 month), or persistent (at both times). Outcomes at 6 months included (1) all-cause rehospitalization or mortality and (2) health status (angina, physical limitation, and quality of life using the Seattle Angina Questionnaire).
Results Compared with nondepressed patients, all categories of depression were associated with higher rehospitalization or mortality rates, more frequent angina, more physical limitations, and worse quality of life. The adjusted hazard ratios for rehospitalization or mortality were 1.34, 1.71, and 1.42 for transient, new, and persistent depression, respectively (all P<.05). Corresponding odds ratios were 1.62, 2.73, and 2.64 (all P<.01) for angina and 1.69, 2.25, and 3.27 (all P<.05) for physical limitation. Depressive symptoms showed a stronger association with health status compared with traditional measures of disease severity.
Conclusion Depressive symptoms after MI, irrespective of whether they persist, subside, or newly develop in the first month after hospitalization, are associated with worse outcomes after MI.
Author Affiliations: Divisions of General Medicine (Dr Parashar) and Cardiology (Drs Wenger, Dawood, and Vaccarino), Department of Medicine, Emory University School of Medicine, Atlanta, Ga; Denver VA Medical Center, Denver, Colo (Dr Rumsfeld); Mid America Heart Institute, Kansas City, Mo (Drs Spertus, and Amin and Ms Reid); Section of Cardiovascular Medicine, Department of Medicine (Dr Krumholz) and Department of Epidemiology and Public Health (Drs Krumholz and Lichtman), Yale University School of Medicine, New Haven, Conn; and Center for Heart and Vascular Health, Christiana Hospital, Wilmington, Del (Dr Weintraub).
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