The Significance of Depression in Older Patients After Myocardial Infarction
- 28 May 2002
- journal article
- research article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 50 (5), 817-822
- https://doi.org/10.1046/j.1532-5415.2002.50205.x
Abstract
OBJECTIVES: Depression is common in patients recovering from a myocardial infarction (MI) and is an independent risk factor for early mortality. Although most patients with MI are aged 65 and older, there is little information about post‐MI depression in this age group. This study was performed to determine the significance of post‐MI depression in individuals aged 65 and older. DESIGN: A cohort study of hospitalized patients and a telephone interview 4 months later. SETTING: A university‐affiliated teaching hospital in Baltimore, Maryland. PARTICIPANTS: Patients admitted with an acute MI (N = 284), 153 (53.9%) of whom were aged 65 and older; 101 of these (66.0%) completed the 4‐month follow‐up interview. MEASUREMENTS: Patients were interviewed 3 to 5 days post‐MI to evaluate for the presence of symptoms of depression (a score of ≥10 on the Beck Depression Inventory and for the presence of mood disorder using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised, Third Edition. Survivors were then interviewed by telephone 4 months after discharge to assess adherence to recommendations to reduce cardiac risk by using the Medical Outcomes Study Specific Adherence Scale. Comorbidities and prescribed medications were determined by review of hospital charts and computerized medical records. RESULTS: Older patients with depression were more likely to die in the first 4 months than older patients without depression (26.5% vs 7.3%, P = .002). Older patients with depression were also more likely than older patients without depression to have had a prior MI (54.3% vs 31.0%, P = .012) and were somewhat more likely to have chronic lung disease (28.6% vs 14.4%, P = .054), a non‐Q wave MI (88.6% vs 72.8%, P = .054), diabetes mellitus (48.6% vs 32.5%, P = .082), and a left ventricular ejection fraction below 35% (50.0% vs 33.3%, P = .084). Compared with older patients without depression, depressed older patients were also marginally less likely at discharge to be prescribed a beta‐blocker (74.3% vs 86.3%, P = .092) or a lipid‐lowering agent (31.4% vs 49.6%, P = .059). Depressed patients aged 65 and older were less likely to adhere to a low‐fat/low‐cholesterol diet (P < .01) or a diabetic diet (P < .01), or to be taking prescribed medications (P < .05), exercising regularly (P < .01), reducing stress (P < .01), and increasing social support (P < .01). CONCLUSION: Depression is prevalent after an acute MI in patients aged 65 and older. Older post‐MI patients with depression have more comorbidities than older patients without depression and have almost four times the risk of dying within the first 4 months after discharge. Although this increased risk is likely to be related to many factors, our data suggest that sicker patients who are older and depressed may less often be prescribed medications known to reduce post‐MI mortality and may also have greater difficulty following recommendations to reduce cardiac risk than their counterparts without depression. Efforts to improve adherence to post‐MI treatment guidelines and to enhance patient compliance may improve prognosis in this high‐risk group.Keywords
This publication has 28 references indexed in Scilit:
- Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD): Study design and methodsAmerican Heart Journal, 2000
- An open-label preliminary trial of sertraline for treatment of major depression after acute myocardial infarction (the SADHAT Trial)American Heart Journal, 1999
- Variations in the Utilization of Coronary Angiography for Elderly Patients with an Acute Myocardial InfarctionPublished by Ovid Technologies (Wolters Kluwer Health) ,1995
- Major depression and medication adherence in elderly patients with coronary artery disease.Health Psychology, 1995
- Depression following Myocardial InfarctionThe International Journal of Psychiatry in Medicine, 1992
- Health complaints, stress, and distress: Exploring the central role of negative affectivity.Psychological Review, 1989
- Factors leading to shorter survival after acute myocardial infarction in patients ages 65 to 75 years compared with younger patientsThe American Journal of Cardiology, 1988
- Psychological distress as a predictor of ventricular arrhythmias in a post-myocardial infarction populationAmerican Heart Journal, 1988
- Psychological response to an acute coronary event and its effect on subsequent rehabilitation and lifestyle changeClinical Cardiology, 1987
- Influence of Adherence to Treatment and Response of Cholesterol on Mortality in the Coronary Drug ProjectNew England Journal of Medicine, 1980