Natalie Szpakowski1, Maria C Bennell1, Feng Qiu1, Dennis T Ko1, Jack V Tu1, Paul Kurdyak1, Harindra C Wijeysundera2. 1. From the Schulich Heart Centre, Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Center (N.S., M.C.B., D.T.K., J.V.T., H.C.W.), Sunnybrook Research Institute (M.C.B., D.T.K., J.V.T., H.C.W.), Institute for Health Policy Management and Evaluation (D.T.K., J.V.T., P.K., H.C.W.), and Department of Psychiatry and Institute of Medical Science (P.K.), University of Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.Q., D.T.K., J.V.T., P.K., H.C.W.); and Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (P.K.). 2. From the Schulich Heart Centre, Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Center (N.S., M.C.B., D.T.K., J.V.T., H.C.W.), Sunnybrook Research Institute (M.C.B., D.T.K., J.V.T., H.C.W.), Institute for Health Policy Management and Evaluation (D.T.K., J.V.T., P.K., H.C.W.), and Department of Psychiatry and Institute of Medical Science (P.K.), University of Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.Q., D.T.K., J.V.T., P.K., H.C.W.); and Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (P.K.). harindra.wijeysundera@sunnybrook.ca.
Abstract
BACKGROUND: Depression is prevalent among patients with myocardial infarction and is associated with a worse prognosis. However, little is known about its importance in patients with chronic stable angina. We conducted a retrospective population-based cohort study to determine the occurrence and predictors of developing depression in patients with a new diagnosis of chronic stable angina. In addition, we sought to understand its impact on subsequent clinical outcomes. METHODS AND RESULTS: Our cohort included patients in Ontario, Canada, with stable angina based on obstructive coronary artery disease found on angiogram. Depression was ascertained by physician billing codes and hospital admissions diagnostic codes. We first developed multivariable Cox proportional hazards models to determine predictors of developing depression. Clinical outcomes of interest included all-cause mortality, admission for myocardial infarction, and subsequent revascularization. Using hierarchical multivariable Cox proportional hazards models with occurrence of depression as a time-varying variable to control for potential immortal time bias, we evaluated the impact of depression on clinical outcomes. Our cohort consisted of 22 917 patients. The occurrence of depression after diagnosis of stable chronic angina was 18.8% over a mean follow-up of 1084 days. Predictors of depression included remote history of depression, female sex, and more symptomatic angina based on Canadian Cardiovascular Society class. Patients who developed depression had a higher risk of death (hazard ratio 1.83, 95% confidence interval 1.62-2.07) and admission for myocardial infarction (hazard ratio 1.36, 95% confidence interval 1.10-1.67) compared with nondepressed patients. CONCLUSIONS: Depression is common in patients with chronic stable angina and is associated with increased morbidity and mortality.
BACKGROUND:Depression is prevalent among patients with myocardial infarction and is associated with a worse prognosis. However, little is known about its importance in patients with chronic stable angina. We conducted a retrospective population-based cohort study to determine the occurrence and predictors of developing depression in patients with a new diagnosis of chronic stable angina. In addition, we sought to understand its impact on subsequent clinical outcomes. METHODS AND RESULTS: Our cohort included patients in Ontario, Canada, with stable angina based on obstructive coronary artery disease found on angiogram. Depression was ascertained by physician billing codes and hospital admissions diagnostic codes. We first developed multivariable Cox proportional hazards models to determine predictors of developing depression. Clinical outcomes of interest included all-cause mortality, admission for myocardial infarction, and subsequent revascularization. Using hierarchical multivariable Cox proportional hazards models with occurrence of depression as a time-varying variable to control for potential immortal time bias, we evaluated the impact of depression on clinical outcomes. Our cohort consisted of 22 917 patients. The occurrence of depression after diagnosis of stable chronic angina was 18.8% over a mean follow-up of 1084 days. Predictors of depression included remote history of depression, female sex, and more symptomatic angina based on Canadian Cardiovascular Society class. Patients who developed depression had a higher risk of death (hazard ratio 1.83, 95% confidence interval 1.62-2.07) and admission for myocardial infarction (hazard ratio 1.36, 95% confidence interval 1.10-1.67) compared with nondepressed patients. CONCLUSIONS:Depression is common in patients with chronic stable angina and is associated with increased morbidity and mortality.
Authors: Patricia Oliveira Guimarães; Christopher B Granger; Amanda Stebbins; Karen Chiswell; Claes Held; Judith S Hochman; Susan Krug-Gourley; Eva Lonn; Renato D Lopes; Ralph A H Stewart; Dragos Vinereanu; Lars Wallentin; Harvey D White; Emil Hagström; Nicolas Danchin Journal: J Am Heart Assoc Date: 2017-09-14 Impact factor: 5.501
Authors: Nina Rieckmann; Konrad Neumann; Sarah Feger; Paolo Ibes; Adriane Napp; Daniel Preuß; Henryk Dreger; Gudrun Feuchtner; Fabian Plank; Vojtěch Suchánek; Josef Veselka; Thomas Engstrøm; Klaus F Kofoed; Stephen Schröder; Thomas Zelesny; Matthias Gutberlet; Michael Woinke; Pál Maurovich-Horvat; Béla Merkely; Patrick Donnelly; Peter Ball; Jonathan D Dodd; Mark Hensey; Bruno Loi; Luca Saba; Marco Francone; Massimo Mancone; Marina Berzina; Andrejs Erglis; Audrone Vaitiekiene; Laura Zajanckauskiene; Tomasz Harań; Malgorzata Ilnicka Suckiel; Rita Faria; Vasco Gama-Ribeiro; Imre Benedek; Ioana Rodean; Filip Adjić; Nada Čemerlić Adjić; José Rodriguez-Palomares; Bruno Garcia Del Blanco; Katriona Brooksbank; Damien Collison; Gershan Davis; Erica Thwaite; Juhani Knuuti; Antti Saraste; Cezary Kępka; Mariusz Kruk; Theodora Benedek; Mihaela Ratiu; Aleksandar N Neskovic; Radosav Vidakovic; Ignacio Diez; Iñigo Lecumberri; Michael Fisher; Balazs Ruzsics; William Hollingworth; Iñaki Gutiérrez-Ibarluzea; Marc Dewey; Jacqueline Müller-Nordhorn Journal: Health Qual Life Outcomes Date: 2020-05-14 Impact factor: 3.186