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Background: Conflicting findings have emerged from studies examining the impact of depression on death and readmission following a coronary event, possibly reflecting differences in the measurement of “depression” and the onset of depression in relation to the coronary event. The aim of this study was to examine the relationship between the timing of the depressive episode and 1-year cardiovascular outcome in recruited patients with acute coronary syndrome (ACS). Methods: Patients hospitalized with ACS (N = 489) were recruited and assessed for lifetime and current depression by the Composite International Diagnostic Interview (CIDI) depression schedule. Patients were reinterviewed at 1 and 12 months by telephone to assess depression status and cardiovascular outcomes (ACS readmission and cardiac mortality). Mortality registers were also checked. Results: Cardiovascular outcome was not associated with the presence of lifetime depression before the ACS admission or with existing depression at the time of the ACS admission. In contrast, depression that developed in the month after the ACS event showed a strong relationship with subsequent cardiovascular outcome, even after controlling for traditional cardiac risk factors. Outcome over the 12 months was more strongly predicted by the timing of depression onset than whether the depression was a first-ever (incident) or recurrent episode. Conclusions: Only a depressive episode that commenced following an ACS admission was associated with a poorer cardiovascular outcome. If confirmed, this finding would narrow the list of causal mechanisms previously proposed to account for the relationship between depression and coronary events. [Copyright &y& Elsevier]

Background In Australia it has been suggested that heart valve surgery, particularly for rheumatic heart disease (RHD), should be consolidated in higher volume centres. International studies of cardiac surgery suggest large volume centres have superior outcomes. However the effect of site and surgeon case load on longer term outcomes for valve surgery has not been investigated. Methods The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed. The adjusted association between both average annual site and surgeon case load on short term complications and short and long-term survival was determined. Results Outcomes associated with 20,116 valve procedures at 25 surgical sites and by 93 surgeons were analysed. Overall adjusted analysis showed increasing site and surgeon case load was associated with longer ventilation, less reoperation and more anticoagulant complications. Increasing surgeon case load was also associated with less acute kidney injury. Adjusted 30-day mortality was not associated with site or surgeon case load. There was no consistent relationship between increasing site case load and long term survival. The association between surgeon case load and outcome demonstrated poorer adjusted survival in the highest volume surgeon group. Conclusions In this Australian study, the adjusted association between surgeon and site case load was not simple or consistent. Overall larger volume sites or surgeons did not have superior outcomes. Mandating a particular site case load level for valve surgery or a minimum number of procedures for individual surgeons, in an Australian context, cannot be supported by these findings. [ABSTRACT FROM AUTHOR]

Abstract: As deficiencies in n-3 PUFAs have been linked separately to depression and to cardiovascular disease, they could act as a higher order variable contributing to the established link between depression and cardiovascular disease. We therefore examine the relationship between depression and omega-3 polyunsaturated fatty acids (n-3 PUFA), including total n-3 PUFA, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), in patients with acute coronary syndrome (ACS). Plasma phospholipid levels of n-3 PUFA were measured in 100 patients hospitalized with ACS. Current major depressive episode was assessed by the Composite International Diagnostic Interview (CIDI). Depression severity was assessed by the 18-item Depression in the Medically Ill (DMI-18) measure. Patients clinically diagnosed with current depression had significantly lower mean total n-3 PUFA and DHA levels. Higher DMI-18 depression severity scores were significantly associated with lower DHA levels, with similar but non-significant trends observed for EPA and total n-3 PUFA levels. The finding that low DHA levels were associated with depression variables in ACS patients may explain links demonstrated between cardiovascular health and depression, and may have prophylactic and treatment implications. [Copyright &y& Elsevier]