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Depression and self-reported functional status: impact on mortality following acute myocardial infarction.
- Source :
-
Journal of Evaluation in Clinical Practice . Jun2011, Vol. 17 Issue 3, p444-451. 8p. 3 Charts, 4 Graphs. - Publication Year :
- 2011
-
Abstract
- The cause of increased post-AMI (acute myocardial infarction) mortality associated with depression remains poorly elucidated. The objective of this study was to examine the extent to which self-reported cardiac functional status accounted for depression-mortality associations following AMI. Using a prospective cohort design ( n = 1941), the authors obtained self-reported measures of depression and developed profiles of the patients' pre-hospitalization cardiac risks, co-morbid conditions and drugs and revascularization procedures during or following index AMI hospitalization. To create these profiles, the patients' self-reports were retrospectively linked to no less than 12 years' worth of previous hospitalization data. Mortality rates 2 years after acute MI were examined with and without sequential risk adjustment for age, sex, income, cardiovascular risk, co-morbid conditions, selected process-of-care factors and self-reported cardiac functional status. Depression was strongly correlated with 2-year mortality rate [crude hazard ratio (HR) of severe vs. minimal depression category, 2.48 (95% CI 1.20-5.15); P = 0.01]. However, after sequential adjustment for age, sex, income and self-reported cardiac functional status, the effect of depression was greatly attenuated [adjusted HR for severe vs. minimal depression category, 1.35 (95% CI 0.63-2.87); P = 0.44]. Cardiac risk factors and non-cardiac co-morbidities had negligible explanatory effect. The main factor determining the increased mortality rate in depressed patients is self-reported cardiac functional status. Efforts to address increased mortality in depressed patients with cardiovascular illnesses should focus on processes that impact cardiac functional status. [ABSTRACT FROM AUTHOR]
- Subjects :
- *CARDIOVASCULAR diseases risk factors
*MYOCARDIAL infarction
*COMPUTER software
*CONFIDENCE intervals
*MENTAL depression
*INTERVIEWING
*LIFE skills
*LONGITUDINAL method
*MULTIVARIATE analysis
*SCIENTIFIC observation
*RESEARCH funding
*SELF-evaluation
*TELEPHONES
*COMORBIDITY
*DATA analysis
*PROPORTIONAL hazards models
*RETROSPECTIVE studies
*PSYCHOLOGY
*PROGNOSIS
MYOCARDIAL infarction-related mortality
Subjects
Details
- Language :
- English
- ISSN :
- 13561294
- Volume :
- 17
- Issue :
- 3
- Database :
- Academic Search Index
- Journal :
- Journal of Evaluation in Clinical Practice
- Publication Type :
- Academic Journal
- Accession number :
- 60602266
- Full Text :
- https://doi.org/10.1111/j.1365-2753.2010.01446.x