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Multicenter Study
. 2018 Mar 1;3(3):191-197.
doi: 10.1001/jamacardio.2017.5064.

Association of Depression With Mortality in Older Adults Undergoing Transcatheter or Surgical Aortic Valve Replacement

Laura M Drudi  1   2   3 , Matthew Ades  3 , Sena Turkdogan  3 , Caroline Huynh  3 , Sandra Lauck  4 , John G Webb  4 , Nicolo Piazza  5 , Giuseppe Martucci  5 , Yves Langlois  6 , Louis P Perrault  7 , Anita W Asgar  8 , Marino Labinaz  9 , Andre Lamy  10 , Nicolas Noiseux  11 , Mark D Peterson  12 , Rakesh C Arora  13 , Brian R Lindman  14 , Melissa Bendayan  1   15 , Rita Mancini  1 , Amanda Trnkus  1 , Dae H Kim  16 , Jeffrey J Popma  17 , Jonathan Afilalo  1   3   15   18
Affiliations
Multicenter Study

Association of Depression With Mortality in Older Adults Undergoing Transcatheter or Surgical Aortic Valve Replacement

Laura M Drudi et al. JAMA Cardiol. .

Abstract

Importance: Depression is increasingly recognized as a risk factor for adverse outcomes in cardiovascular disease. However, little is known about depression in older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement.

Objective: To determine the prevalence of depression and its association with all-cause mortality in older adults undergoing TAVR or SAVR.

Design, setting, and participants: This preplanned analysis of the Frailty Aortic Valve Replacement (FRAILTY-AVR) prospective cohort study included 14 centers in 3 countries from November 15, 2011, through April 7, 2016. Individuals 70 years or older who underwent TAVR or SAVR were enrolled. Depressive symptoms were evaluated using the Geriatric Depression Scale Short Form at baseline and follow-up.

Main outcomes and measures: All-cause mortality at 1 and 12 months after TAVR or SAVR. Logistic regression was used to determine the association of depression with mortality after adjusting for confounders such as frailty and cognitive impairment.

Results: Among 1035 older adults (427 men [41.3%] and 608 women [58.7%]) with a mean (SD) age of 81.4 (6.1) years, 326 (31.5%) had a positive result of screening for depression, whereas only 89 (8.6%) had depression documented in their clinical record. After adjusting for clinical and geriatric confounders, baseline depression was found to be associated with mortality at 1 month (odds ratio [OR], 2.20; 95% CI, 1.18-4.10) and at 12 months (OR, 1.532; 95% CI, 1.03-2.24). Persistent depression, defined as baseline depression that was still present 6 months after the procedure, was associated with a 3-fold increase in mortality at 12 months (OR, 2.98; 95% CI, 1.08-8.20).

Conclusions and relevance: One in 3 older adults undergoing TAVR or SAVR had depressive symptoms at baseline and a higher risk of short-term and midterm mortality. Patients with persistent depressive symptoms at follow-up had the highest risk of mortality.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Drudi reports receiving grants from Canadian Institutes for Health Research (CIHR)–Canada Graduate Scholarship and Fonds de Recherche du Quebec Masters Award during the conduct of the study. Ms Turkdogan reports receiving grants from CIHR during the conduct of the study. Dr Lauck reports consulting for Edwards Lifesciences. Dr Webb reports receiving grants and personal fees from and consulting for Edwards Lifesciences and Abbott Vascular. Dr Piazza reports consulting for Highlife, Microport, Boston Scientific, and Medtronic. Dr Martucci reports consulting and serving as proctor for Boston Scientific and Medtronic. Dr Perrault reports consulting for Somahlution and serving on an advisory board for Clearflow. Dr Asgar reports consulting for Edwards Lifesciences and Medtronic. Dr Peterson reports serving as a proctor for Edwards Lifesciences. Dr Arora reports receiving grants from Pfizer Canada Inc and other support from Mallinckrodt Pharmaceutics outside the submitted work. Dr Lindman reports receiving grants from Edwards Lifesciences and personal fees from Medtronic during the conduct of the study, grants and personal fees from and serving on an advisory board for Roche Diagnostics, and grant support from Edwards Lifesciences. Dr Kim reports receiving grants from Harvard Catalyst during the conduct of the study and personal fees for consulting from Alosa Health. Dr Popma reports receiving institutional grants from Medtronic and serving on advisory boards for Boston Scientific and Abbott Vascular. No other disclosures were reported.

Figures

Figure.
Figure.. Kaplan-Meier Survival Curves by Baseline Depression Status
At 12 months, 62 deaths (19.0%) were observed among 326 patients with depression and 83 deaths (11.7%) were observed in 709 patients without depression. AVR indicates aortic valve replacement; OR, odds ratio.
See this image and copyright information in PMC

Comment in

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