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CLINICAL RESEARCH: HEART FAILURE

Depression After Coronary Artery Disease Is Associated With Heart Failure

Heidi T. May, PhD, MSPH^_*,_*, Benjamin D. Horne, PhD, MPH^_*,, John F. Carlquist, PhD^_*, Xiaoming Sheng, PhD, Elizabeth Joy, MD, MPH and A. Peter Catinella, MD, MPH

^_* Intermountain Medical Center, Murray, Utah
University of Utah, Salt Lake City, Utah

Manuscript received November 19, 2008; revised manuscript received December 16, 2008, accepted January 14, 2009.

^_* Reprint requests and correspondence: Dr. Heidi T. May, Intermountain Medical Center, Cardiovascular Research, 5121 South Cottonwood Street, Murray, Utah 84157 (Email: Heidi.May{at}imail.org).

Objectives: The purpose of this study was to evaluate the influence of post-coronary artery disease (CAD) depression diagnosis on heart failure (HF) incidence.

Background: Depression has been shown to be a risk factor for poor outcomes among CAD patients. However, little is known about the influence of depression on HF development in CAD patients.

Methods: Patients (n = 13,708) without a diagnosis of HF and depression (International Classification of Diseases-Ninth Revision [ICD-9] codes: 296.2 to 296.36 and 311) and who were not prescribed antidepressant medication (ADM) at the time of CAD diagnosis (70% stenosis) were studied. For those with available medication records (n = 7,719), patients subsequently diagnosed with depression were stratified by use of ADM. Patients were followed until HF diagnosis (physician-diagnosed or ICD-9 code: 428) or death. Results were analyzed by Cox proportional hazards regression models.

Results: A total of 1,377 patients (10.0%) had a post-CAD clinical depression diagnosis. The incidence of HF among those without a post-CAD depression diagnosis was 3.6 per 100 compared with 16.4 per 100 for those with a post-CAD depression diagnosis. Depression was associated with an increased risk for HF incidence (adjusted hazard ratio [HR]: 1.50, p < 0.0001). Results were similar among those with available follow-up medication information (vs. no depression: depression without ADM use [HR: 1.68, p < 0.0001]; depression with ADM use [HR: 2.00, p < 0.0001]). No difference was found between depressed patients with and without ADM treatment (HR: 0.84, p = 0.24).

Conclusions: Depression diagnosis was shown to be associated with an increased incidence of HF after CAD diagnosis, regardless of ADM treatment. This finding suggests the need to further study the effect of depression on HF risk among CAD patients.

Key Words: depression • heart failure • antidepressant • medication

Abbreviations and Acronyms   ACEI = angiotensin-converting enzyme inhibitor   ADM = antidepressant medication   CAD = coronary artery disease   CI = confidence interval   CV = cardiovascular   EF = ejection fraction   HF = heart failure   HR = hazard ratio   MI = myocardial infarction

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