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Transient impact of baseline depression on mortality in patients with stable coronary heart disease during long-term follow-up

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Abstract

Objective

The objective of this prospective study was to determine the impact of depressive symptoms on long-term survival in coronary heart disease (CHD) patients treated with intracoronary stenting.

Methods

Four hundred and seventy patients completed the Hospital Anxiety and Depression Scale (HADS) before undergoing stent implantation and were followed over a 5-year period. Survival data were collected from n = 462 participants (98.3 %). A cut-off ≥8 on the HADS depression subscale was used to indicate probable clinical levels of depression.

Results

All-cause mortality rates differed significantly between depressed and non-depressed patients at 2-year follow-up, as 6 out of 98 subjects with elevated HADS-D scores (6.1 %), but only 8 out of 364 (2.2 %) patients with normal HADS-D scores had died [odds ratio = 2.9, 95 % confidence interval (95 % CI) = 1.0–8.6, p = 0.044]. In a Cox regression model adjusted for sociodemographic and clinical parameters, positive HADS-D scores [hazard ratio (HR) = 4.3, 95 % CI = 1.2–15.4, p = 0.025], body-mass index (HR = 0.8, 95 % CI = 0.7–1.0, p = 0.040) and stent length (HR = 1.1, 95 % CI = 1.0–1.1, p = 0.042) independently predicted 2-year survival. From the third to the fifth year after index PCI, the frequency of deaths in the depressed patients’ group did not significantly differ from that observed in non-depressed patients (5.5 % versus 7.0 %, p = 0.607), and the predictive role of baseline HADS-D scores for survival was lost.

Conclusion

In CHD patients, self-rated depressive symptoms at baseline were negatively linked to survival at 2-year follow-up, but failed to predict mortality 3 years later. Thus, in contrast to other well-established risk factors, the prognostic value of depression for predicting adverse outcome may be temporarily limited. The mechanisms behind this transient effect need further study.

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Acknowledgments

The authors particularly thank Dr. Mohammad N. Pasalary, Bremen, for expert assistance in data acquisition.

Conflict of interest

CHL receives royalties from Hans Huber Publishers, Berne, for the German version of the HADS. The remaining authors declare no conflict of interest.

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Authors and Affiliations

  1. Klinik für Psychosomatische Medizin und Psychotherapie, Deutsches Zentrum für Herz- und Kreislaufforschung, Universität Göttingen, von-Siebold-Str. 5, 37075, Göttingen, Germany

    Thomas Meyer, Sharif Hussein & Christoph Herrmann-Lingen

  2. Kardiologisch-angiologische Praxis, Herzzentrum Bremen, Bremen, Germany

    Helmut W. Lange

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  1. Thomas Meyer
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  2. Sharif Hussein
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  4. Christoph Herrmann-Lingen
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Correspondence to Thomas Meyer.

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Meyer, T., Hussein, S., Lange, H.W. et al. Transient impact of baseline depression on mortality in patients with stable coronary heart disease during long-term follow-up. Clin Res Cardiol 103, 389–395 (2014). https://doi.org/10.1007/s00392-014-0666-6

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  • DOI: https://doi.org/10.1007/s00392-014-0666-6

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