Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2015; 7(4): 215-223
Published online Apr 26, 2015. doi: 10.4330/wjc.v7.i4.215
Effective treatment of depression improves post-myocardial infarction survival
Soudabeh Khojasteh Banankhah, Erika Friedmann, Sue Thomas
Soudabeh Khojasteh Banankhah, Erika Friedmann, Sue Thomas, School of Nursing, University of Maryland, Baltimore, MD 21201, United States
Author contributions: Banankhah SK contributed to the conception of the study; Banankhah SK and Thomas S designed; Friedmann E contributed to acquisition of data; Banankhah SK and Friedmann E analyzed and interpreted the data; Banankhah SK wrote the paper; Banankhah SK, Friedmann E and Thomas S revised the manuscript for final submission.
Ethics approval: The study was reviewed and approved by the University of Maryland Institutional Review Board.
Clinical trial registration: This study is registered at http://clinicaltrial.gov/ct2/show/NCT00000557?term=ENRICHD&rank=1, The clinical Trials.gov Identifier: NCT00000557.
Informed consent: This study is a secondary data analysis using data from the ENRICHD randomized trial and received in a de-identified format.
Conflict-of-interest: The authors have no relationships with industry to report and have no conflict of interest including financial, personal, political interest in this study.
Data sharing: Technical appendix and statistical code are available from the corresponding author at sbana001@umaryland.edu. The ENRICHD limited use data set is available from NIH by application through BIOLINCC at https://biolincc.nhlbi.nih.gov/home/
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Soudabeh Khojasteh Banankhah, CRNP, CRNA, PhD, School of Nursing, University of Maryland, 655 W. Lombard St., Room 316, Baltimore, MD 21201, United States. sbanank1@jhmi.edu
Telephone: +1-410-7060659
Received: October 22, 2014
Peer-review started: October 22, 2014
First decision: November 27, 2014
Revised: January 7, 2015
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: April 26, 2015
Processing time: 180 Days and 8 Hours
Abstract

AIM: To examine the contribution of treatment resistant depression (TRD) to mortality in depressed post-myocardial infarction (MI) patients independent of biological and social predictors.

METHODS: This secondary analysis study utilizes the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial data. From 1834 depressed patients in the ENRICHD study, there were 770 depressed post-MI patients who were treated for depression. In this study, TRD is defined as having a less than 50% reduction in Hamilton Depression (HAM-D) score from baseline and a HAM-D score of greater than 10 in 6 mo after depression treatment began. Cox regression analysis was used to examine the independent contributions of TRD to mortality after controlling for the biological and social predictors.

RESULTS: TRD occurred in 13.4% (n = 103) of the 770 patients treated for depression. Patients with TRD were significantly younger in age (P = 0.04) (mean = 57.0 years, SD = 11.7) than those without TRD (mean = 59.2 years, SD = 12.0). There was a significantly higher percentage of females with TRD (57.3%) compared to females without TRD (47.4%) [χ2 (1) = 4.65, P = 0.031]. There were significantly more current smokers with TRD (44.7%) than without TRD (33.0%) [χ2 (1) = 7.34, P = 0.007]. There were no significant differences in diabetes (P = 0.120), history of heart failure (P = 0.258), prior MI (P = 0.524), and prior stroke (P = 0.180) between patients with TRD and those without TRD. Mortality was 13% (n = 13) in patients with TRD and 7% (n = 49) in patients without TRD, with a mean follow-up of 29 mo (18 mo minimum and maximum of 4.5 years). TRD was a significant independent predictor of mortality (HR = 1.995; 95%CI: 1.011-3.938, P = 0.046) after controlling for age (HR = 1.036; 95%CI: 1.011-1.061, P = 0.004), diabetes (HR = 2.912; 95%CI: 1.638-5.180, P < 0.001), heart failure (HR = 2.736; 95%CI: 1.551-4.827, P = 0.001), and smoking (HR = 0.502; 95%CI: 0.228-1.105, P = 0.087).

CONCLUSION: The analysis of TRD in the ENRICHD study shows that the effective treatment of depression reduced mortality in depressed post-MI patients. It is important to monitor the effectiveness of depression treatment and change treatments if necessary to reduce depression and improve cardiac outcomes in depressed post-MI patients.

Keywords: Depression treatment; Post-myocardial infarction; Mortality; Anti-depressant; Cognitive behavioral therapy

Core tip: Treatment resistant depression (TRD) was associated with increased mortality in post-myocardial infarction (MI) patients with depression. Conversely, effective treatment of depression with cognitive behavioral therapy with or without medication decreased mortality in post-MI patients who were depressed. Since TRD post-MI patients are at higher risk for mortality, closer follow-up and more aggressive treatment for depression and risk factor modification is needed to improve patient outcome. It is important to monitor the effectiveness of depression treatment and change treatments if necessary to reduce depression and improve cardiac outcomes in post-MI patients with depression.