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The Trajectory of Depression in Acute-MI Patients

No matter when depressive symptoms were evident during the 1 month after acute MI, they were associated with increased risk for rehospitalization within 6 months.

Depressive symptoms are common after acute MI and are associated with increased risk for adverse post-MI outcomes. However, in some affected patients, the symptoms don’t persist very long; in others, symptoms of depression surface after the MI hospitalization.

To explore the trajectory of depression in hospitalized acute-MI patients, the PREMIER investigators studied 1881 such patients who had follow-up at 1 month. According to Patient Health Questionnaire responses, 1382 patients had no depressive symptoms at hospitalization or at 1 month, 253 had depressive symptoms in the hospital but not at 1 month (transient depression), 112 had no depressive symptoms in the hospital but did at 1 month (new depression), and 134 had depressive symptoms at both junctures (persistent depression).

Compared to patients with no depressive symptoms at either time point, the three other groups each had significantly higher adjusted hazard ratios for a composite endpoint of rehospitalization or mortality by 6 months (persistent group, 1.42; new group, 1.71; transient group, 1.34), mostly due to rehospitalization. The three groups with depressive symptoms were also more likely than the nondepressed group to have angina or physical limitations, and their mean quality-of-life scores were lower.

Comment: Depressive symptoms after acute MI may be persistent, transient, or appear anew in early follow-up. Regardless of the trajectory, however, when such symptoms do occur in acute-MI patients, they are associated with increased risk for adverse outcomes. Although the optimal approach to different subgroups might vary, the present data support screening for depression during acute-MI hospitalizations and in follow-up, to identify patients who might benefit from more intensive surveillance and treatment.

— Frederick A. Masoudi, MD, MSPH

Published in Journal Watch Cardiology November 17, 2006

Citation(s):

Parashar S et al. for the PREMIER Registry Investigators. Time course of depression and outcome of myocardial infarction. Arch Intern Med 2006 Oct 9; 166:2035-43.

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