Predictive value of depression and anxiety for long-term mortality: differences in outcome between acute coronary syndrome and stable angina pectoris
Introduction
Over the past decades, many studies have examined the relation between depression or anxiety and prognosis in patients treated for acute coronary syndrome (ACS). However, since the early 2000s treatment for ACS has moved from thrombolytic therapy to primary PCI (pPCI) and the association between depression or anxiety and long-term outcome has not been thoroughly investigated since then [1], [2], [3]. Prevalence rates of depression and anxiety in patients with coronary artery disease (CAD) in general vary from 10% to 50% [4], [5], [6], [7], [8], [9], [10]. Targeting psychological symptoms may provide improvements to the prognosis and quality of life in patients with CAD [11].
Depression and anxiety symptoms are associated with an increased mortality risk in post-PCI patients [6], [7], [12]. Previous research from our group showed a 77% higher 10-year mortality risk in post-PCI patients with depression compared to patients without depression. Moreover, a 50% higher 10-year mortality in anxious patients was found compared to non-anxious patients [7]. This study however, included patients in 2002, the beginning of the drug eluting stent era. At that time pPCI was a much less frequent (14%) indication for PCI than our population (31%) [3], [7]. This difference is important as previous studies demonstrated that PCI indication is associated with different cardiovascular morbidity and mortality rates post-PCI [13], [14].
In contrast, several other studies suggested that depression was not associated with higher 5-year mortality [9], whereas anxious patients had a lower mortality at 5 years compared to non-anxious patients after PCI [8], [10]. Considering these contradictory findings, the main objective of this study was to gain further insight by investigating the predictive value of depression and anxiety for 10-year mortality post-PCI, in a large longitudinal cohort with patients treated in 2006 for stable angina pectoris (SA) versus patients treated for acute coronary syndrome (ACS).
Section snippets
Study population
This prospective cohort consists of a consecutive series of CAD patients (n = 786) treated with PCI between February and September 2006 at the Erasmus Medical Centre, Rotterdam. In all patients, the paclitaxel-eluting stent was used as the default strategy. The design of this registry has been published previously [15]. At 1 month post-PCI, all surviving patients were contacted by mail and asked to fill in a standardized questionnaire. In total, 535 (68%) of the eligible 786 patients returned the
Patient characteristics
During the study period 528 patients were able and willing to participate in this study. At baseline, 19.7% of patients scored ≥ 8 on the HADS-D scale and 22.9% scored ≥ 8 on the HADS-A scale. Patient characteristics of the total sample and stratified by depression and anxiety are presented in Table 1. Mean age in the population was 63 years and 24% was female. Patient characteristics for the SA and ACS group stratified by depression and anxiety are presented in Table 2. The median follow-up for
Discussion
In a consecutive cohort of PCI patients, anxiety at baseline was associated with an increased 10-year mortality rate after PCI. Depression was also associated with higher 10-year mortality, however the association disappeared after additional adjustment for anxiety. This finding was more pronounced in patients presenting with SA as compared to those presenting with ACS in which there was no association between depression or anxiety and 10-year mortality.
The association between depression or
Conflict of interest
None.
Acknowledgments
None.
References (33)
- et al.
ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee on management of patients with chronic stable angina)
J. Am. Coll. Cardiol.
(1999) - et al.
ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction)
J. Am. Coll. Cardiol.
(2004) - et al.
Effect of depression on late (8 years) mortality after myocardial infarction
Am. J. Cardiol.
(2008) - et al.
Depression is independently associated with 7-year mortality in patients treated with percutaneous coronary intervention: results from the RESEARCH registry
Int. J. Cardiol.
(2013) - et al.
Depression, not anxiety, is independently associated with 5-year hospitalizations and mortality in patients with ischemic heart disease
J. Psychosom. Res.
(2013) - et al.
Can anxiety and depression, separately or in combination predict subjective health status 10 years post-PCI?
Int. J. Cardiol.
(2015) - et al.
Comparison of long-term mortality after percutaneous coronary intervention in patients treated for acute ST-elevation myocardial infarction versus those with unstable and stable angina pectoris
Am. J. Cardiol.
(2009) - et al.
The validity of the Hospital Anxiety and Depression Scale. An updated literature review
J. Psychosom. Res.
(2002) Anxiety disorders in women
Psychiatr. Clin. North Am.
(2003)- et al.
Population trends in percutaneous coronary intervention: 20-year results from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry)
J. Am. Coll. Cardiol.
(2013)
Indication for percutaneous coronary intervention is not associated with symptoms of anxiety and depression
Int. J. Cardiol.
Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses
J. Affect. Disord.
Only incident depressive episodes after myocardial infarction are associated with new cardiovascular events
J. Am. Coll. Cardiol.
Long-term safety of drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis
J. Am. Coll. Cardiol.
Changes in clinical profile, treatment, and mortality in patients hospitalised for acute myocardial infarction between 1985 and 2008
PLoS One
Prevalence of depression in survivors of acute myocardial infarction
J. Gen. Intern. Med.
Cited by (31)
Association between anxiety and mortality in patients with congestive heart failure after implantation of cardiac electronic devices
2022, Journal of Psychosomatic ResearchCitation Excerpt :Severe anxiety symptoms are a factor that prevents changes in lifestyle, diet, and adherence to drug treatment, which leads to an increase in the frequency of readmission and a decrease in the quality of life [5–7]. Consequently, anxiety is one of the most common psychological factors that negatively affect the course and prognosis in patients with cardiovascular disease (CVD) [8,9] and CHF in particular [10]. Research results indicate an association between anxiety disorders with an increased risk of cardiac death and death from all causes in patients with various CVDs [11,12].
Evaluation of the efficacy of a psychological intervention program in a Cardiac Rehabilitation Unit after acute coronary syndrome
2021, Journal of Healthcare Quality ResearchDepression predicts the risk of adverse events after percutaneous coronary intervention: A meta-analysis
2020, Journal of Affective DisordersCitation Excerpt :The characteristics of the studies are shown in Table 1. This meta-analysis included 4555 CAD patients who underwent PCI from nine cohort studies performed in the Netherlands (de Jager et al., 2018; Pedersen et al., 2007; van Dijk et al., 2016), US (Gharacholou et al., 2016), Germany (Meyer et al., 2014), Italy (Compostella et al., 2017), Korea (Park et al., 2015; Yu et al., 2017), and China (Wang et al., 2013), respectively. All of them were prospective cohorts(de Jager et al., 2018; Gharacholou et al., 2016; Meyer et al., 2014; Park et al., 2015; Pedersen et al., 2007; van Dijk et al., 2016; Wang et al., 2013; Yu et al., 2017) except for one study that was a retrospective study (Compostella et al., 2017).
The effect of Xinkeshu tablets on depression and anxiety symptoms in patients with coronary artery disease: Results from a double-blind, randomized, placebo-controlled study
2019, Biomedicine and PharmacotherapyCitation Excerpt :Therefore, anxiety and depression are serious concerns in patients with chronic illnesses such as CAD. Studies have found that depression and anxiety are linked to increased mortality in patients with CAD [4], possibly via increased sympathetic activity and platelet adhesion [23]; however, the mechanism is thought to be multifactorial [11]. Inflammation and cytokines play a major role in synaptic plasticity, and impairments in plasticity are often found among patients with major depressive disorder [16,24].
Person-centered analysis of psychological traits to explain heterogeneity in patient-reported outcomes of coronary artery disease– the THORESCI study
2018, Journal of Affective DisordersCitation Excerpt :However, these meta-analyses also reported substantial heterogeneity in when and how psychosocial factors affect the prognosis of CAD. While several studies in CAD patients showed an association between psychosocial factors, such as anxiety and depression, with major adverse cardiovascular events during follow-up (de Jager et al., 2018; Meyer et al., 2015), other studies did not find these associations (Pelletier et al., 2015). Moreover, a recent study showed large heterogeneity in the prognostic value of individual depressive symptoms in patients with CAD across sex and age subgroups (de Miranda Azevedo et al., 2018).