Laura M Drudi1,2,3, Matthew Ades3, Sena Turkdogan3, Caroline Huynh3, Sandra Lauck4, John G Webb4, Nicolo Piazza5, Giuseppe Martucci5, Yves Langlois6, Louis P Perrault7, Anita W Asgar8, Marino Labinaz9, Andre Lamy10, Nicolas Noiseux11, Mark D Peterson12, Rakesh C Arora13, Brian R Lindman14, Melissa Bendayan1,15, Rita Mancini1, Amanda Trnkus1, Dae H Kim16, Jeffrey J Popma17, Jonathan Afilalo1,3,15,18. 1. Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada. 2. Division of Vascular Surgery, McGill University, Montreal, Quebec, Canada. 3. Faculty of Medicine, McGill University, Montreal, Quebec, Canada. 4. Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 5. Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada. 6. Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. 7. Division of Cardiac Surgery, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada. 8. Division of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada. 9. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 10. Division of Cardiac Surgery, Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. 11. Division of Cardiac Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada. 12. Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 13. Division of Cardiac Surgery, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. 14. Division of Cardiology, Washington University School of Medicine, St Louis, Missouri. 15. Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada. 16. Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts. 17. Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts. 18. Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Abstract
Importance: Depression is increasingly recognized as a risk factor for adverse outcomes in cardiovascular disease. However, little is known about depression in older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement. Objective: To determine the prevalence of depression and its association with all-cause mortality in older adults undergoing TAVR or SAVR. Design, Setting, and Participants: This preplanned analysis of the Frailty Aortic Valve Replacement (FRAILTY-AVR) prospective cohort study included 14 centers in 3 countries from November 15, 2011, through April 7, 2016. Individuals 70 years or older who underwent TAVR or SAVR were enrolled. Depressive symptoms were evaluated using the Geriatric Depression Scale Short Form at baseline and follow-up. Main Outcomes and Measures: All-cause mortality at 1 and 12 months after TAVR or SAVR. Logistic regression was used to determine the association of depression with mortality after adjusting for confounders such as frailty and cognitive impairment. Results: Among 1035 older adults (427 men [41.3%] and 608 women [58.7%]) with a mean (SD) age of 81.4 (6.1) years, 326 (31.5%) had a positive result of screening for depression, whereas only 89 (8.6%) had depression documented in their clinical record. After adjusting for clinical and geriatric confounders, baseline depression was found to be associated with mortality at 1 month (odds ratio [OR], 2.20; 95% CI, 1.18-4.10) and at 12 months (OR, 1.532; 95% CI, 1.03-2.24). Persistent depression, defined as baseline depression that was still present 6 months after the procedure, was associated with a 3-fold increase in mortality at 12 months (OR, 2.98; 95% CI, 1.08-8.20). Conclusions and Relevance: One in 3 older adults undergoing TAVR or SAVR had depressive symptoms at baseline and a higher risk of short-term and midterm mortality. Patients with persistent depressive symptoms at follow-up had the highest risk of mortality.
Importance: Depression is increasingly recognized as a risk factor for adverse outcomes in cardiovascular disease. However, little is known about depression in older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement. Objective: To determine the prevalence of depression and its association with all-cause mortality in older adults undergoing TAVR or SAVR. Design, Setting, and Participants: This preplanned analysis of the Frailty Aortic Valve Replacement (FRAILTY-AVR) prospective cohort study included 14 centers in 3 countries from November 15, 2011, through April 7, 2016. Individuals 70 years or older who underwent TAVR or SAVR were enrolled. Depressive symptoms were evaluated using the Geriatric Depression Scale Short Form at baseline and follow-up. Main Outcomes and Measures: All-cause mortality at 1 and 12 months after TAVR or SAVR. Logistic regression was used to determine the association of depression with mortality after adjusting for confounders such as frailty and cognitive impairment. Results: Among 1035 older adults (427 men [41.3%] and 608 women [58.7%]) with a mean (SD) age of 81.4 (6.1) years, 326 (31.5%) had a positive result of screening for depression, whereas only 89 (8.6%) had depression documented in their clinical record. After adjusting for clinical and geriatric confounders, baseline depression was found to be associated with mortality at 1 month (odds ratio [OR], 2.20; 95% CI, 1.18-4.10) and at 12 months (OR, 1.532; 95% CI, 1.03-2.24). Persistent depression, defined as baseline depression that was still present 6 months after the procedure, was associated with a 3-fold increase in mortality at 12 months (OR, 2.98; 95% CI, 1.08-8.20). Conclusions and Relevance: One in 3 older adults undergoing TAVR or SAVR had depressive symptoms at baseline and a higher risk of short-term and midterm mortality. Patients with persistent depressive symptoms at follow-up had the highest risk of mortality.
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