Depressive Symptoms and Risk of New Cardiovascular Events or Death in Patients with Myocardial Infarction: A Population-Based Longitudinal Study Examining Health Behaviors and Health Care Interventions.

Publikation: Forskning - peer reviewTidsskriftartikel

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Mange mennesker rammes af depression efter en blodprop i hjertet (AMI), og denne kombination er forbundet med en dårligere prognose. Dette studie er det første, der viser, at depression udgør en selv-stændig risikofaktor for tidlig død hos patienter med blodprop i hjertet. Undersøgelsen tyder dog ikke på, at der også er en øget risiko for at få nye hjertetilfælde. Resultaterne tager højde for andre faktorer, der spiller ind på helbredet - fx en sværere grad af hjerte¬sygdom, andre samtidige kroniske sygdomme, for lidt motion, rygning og et lavere medicinforbrug. Den nye viden kan blandt andet bruges til at skærpe opmærksomheden over for denne patientgruppe hos de praktiserende læger, hvor op mod 90 % af alle patienter med depression bliver diagnosticeret og behandlet.


Background: Depressive symptoms is associated with adverse cardiovascular outcomes in patients with myocardial
infarction (MI), but the underlying mechanisms are unclear and it remains unknown whether subgroups of patients are at a
particularly high relative risk of adverse outcomes. We examined the risk of new cardiovascular events and/or death in
patients with depressive symptoms following first-time MI taking into account other secondary preventive factors. We
further explored whether we could identify subgroups of patients with a particularly high relative risk of adverse outcomes.
Methods and Results: We conducted a prospective population-based cohort study of 897 patients discharged with firsttime
MI between 1 January 2009 and 31 December 2009, and followed up until 31 July 2012. Depressive symptoms were
found in 18.6% using the Hospital Anxiety and Depression Scale (HADS-D$8). A total of 239 new cardiovascular events, 95
deaths, and 288 composite events (239 new cardiovascular events and 49 deaths) occurred during 1,975 person-years of
follow-up. Event-free survival was evaluated using Cox regression analysis. Compared to the 730 patients without
depressive symptoms (HADS-D,8), the 167 patients with depressive symptoms (HADS-D$8) had age- and sex-adjusted
hazard ratios [HR] (95% confidence interval [CI]) of 1.53 (95% CI, 1.14–2.05) for a new cardiovascular event, 3.10 (95% CI,
2.04–4.71) for death and 1.77 (95% CI, 1.36–2.31) for a composite event. The associations were attenuated when adjusted for
disease severity, comorbid conditions and physical inactivity; HR = 1.17 (95% CI, 0.85–1.61) for a new cardiovascular event,
HR = 2.01 (95% CI, 1.28–3.16) for death, and HR = 1.33 (95% CI, 1.00–1.76) for a composite event. No subgroups of patients
had a particularly high risk of adverse outcomes.
Conclusions: Depressive symptoms following first-time MI was an independent prognostic risk factor for death, but not for
new cardiovascular events. We found no subgroups of patients with a particularly high relative risk of adverse outcomes.
OriginalsprogEngelsk
TidsskriftPloS one
Vol/bind8/9
Tidsskriftsnummere74393
Sider (fra-til)1-9
Antal sider9
ISSN1932-6203
StatusUdgivet - 25 sep. 2013

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