Friday, January 4, 2008

Persistent post-ACS depression linked to worse physical outcome

Persistent post-ACS depression linked to worse physical outcome

By Caroline Price

04 January 2008

Am J Cardiol 2008; 101: 15-19

MedWire News: Depressive symptoms during hospitalization for acute coronary syndromes (ACS) predict patients’ physical health status 12 months later, study findings show.
However, only patients whose depressive symptoms persist during recovery have significantly poorer physical health than before ACS at 12 months. Patients with transient symptoms are not at risk for worsened physical health.

“These results underscore the importance of assessing depression at the time of ACS and on an ongoing basis,” the study authors say.

Brett Thombs (McGill University, Montreal, Quebec, Canada) and colleagues assessed 425 patients with ACS using the Beck Depression Inventory (BDI) and the Short Form 12 (SF-12) Health Survey during hospitalization and 12 months later.

In all, 123 (28.9%) patients during hospitalization and 102 (24.0%) patients at the 12-month follow-up had at least mild symptoms of depression (BDI ≥10). Based on the “statistically reliable change index” of ≥6.2 points on the BDI, 281 (66.1%) patients were classified as having symptoms not present, 85 (20.0%) as having persistent symptoms, 38 (8.9%) with transient symptoms, and 21 (4.9%) with new symptoms emerging between the index ACS and 12 months after ACS.

The mean BDI score during hospitalization was highest among patients with transient symptoms (19.3), followed by patients with persistent symptoms (14.8), those with symptoms not present (4.2), and those with new symptoms (3.9).

At 12 months, the mean BDI score was highest in those with new symptoms (17.0), followed by the persistent symptom group (14.0), those with transient symptoms (6.3), and patients without symptoms (3.8).

Patients with a BDI score of ≥10 in hospital had significantly poorer health status at 12 months after ACS than patients with lower scores (SF-12 score, 36.7 vs 44.7, p<0.001). Higher BDI scores remained significantly associated with worse physical health at 12 months after controlling for physical health status before ACS, age, gender, diagnosis, history of acute myocardial infarction, and Killip class (p<0.001).

Further analysis replacing baseline BDI score with the symptom classifications during recovery, using symptoms not present as the reference group, showed that persistent symptoms significantly predicted worse physical health at 12 months compared with physical health before ACS (p<0.001).

Meanwhile, new symptoms showed a nonsignificant tendency to predict worse physical health, whereas transient symptoms did not predict worse physical health.

“The findings of this study emphasize the importance of assessing symptoms of depression, not only at the time of the acute ACS hospitalization, but also subsequently during follow-up visits,” the authors conclude in the American Journal of Cardiology.

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