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. 2019 Apr 24;19(1):122.
doi: 10.1186/s12888-019-2113-8.

Is depression a real risk factor for acute myocardial infarction mortality? A retrospective cohort study

Silvia Cocchio  1 , Tatjana Baldovin  1 , Patrizia Furlan  1 , Alessandra Buja  1 , Patrizia Casale  2 , Marco Fonzo  1 , Vincenzo Baldo  3 , Chiara Bertoncello  1
Affiliations

Is depression a real risk factor for acute myocardial infarction mortality? A retrospective cohort study

Silvia Cocchio et al. BMC Psychiatry. .

Abstract

Background: Depression has been associated with a higher risk of cardiovascular events and a higher mortality in patients with one or more comorbidities. This study investigated whether continuative use of antidepressants (ADs), considered as a proxy of a state of depression, prior to acute myocardial infarction (AMI) is associated with a higher mortality afterwards. The outcome to assess was mortality by AD use.

Methods: A retrospective cohort study was conducted in the Veneto Region on hospital discharge records with a primary diagnosis of AMI in 2002-2015. Subsequent deaths were ascertained from mortality records. Drug purchases were used to identify AD users. A descriptive analysis was conducted on patients' demographics and clinical data. Survival after discharge was assessed with a Kaplan-Meier survival analysis and Cox's multiple regression model.

Results: Among 3985 hospital discharge records considered, 349 (8.8%) patients were classified as 'AD users'. The mean AMI-related hospitalization rate was 164.8/100,000 population/year, and declined significantly from 204.9 in 2002 to 130.0 in 2015, but only for AD users (- 40.4%). The mean overall follow-up was 4.6 ± 4.1 years. Overall, 523 patients (13.1%) died within 30 days of their AMI. The remainder survived a mean 5.3 ± 4.0 years. After adjusting for potential confounders, use of antidepressants was independently associated with mortality (adj OR = 1.75, 95% CI: 1.40-2.19).

Conclusions: Our findings show that AD users hospitalized for AMI have a worse prognosis in terms of mortality. The use of routinely-available records can prove an efficient way to monitor trends in the state of health of specific subpopulations, enabling the early identification of AMI survivors with a history of antidepressant use.

Keywords: Acute myocardial infarction; Depression; Epidemiology; Survival.

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Conflict of interest statement

Ethics approval and consent to participate

Data were treated with full confidentiality in accordance with Italian legislation. Before the database was made available to the authors, patient identifiers were replaced with anonymous codes that make it impossible to identify the individuals concerned. It was unnecessary to obtain patients’ informed consent, given the anonymous nature of the data and its mandatory recording (anonymized data may be analyzed and used in aggregate form for scientific studies without further authorization) [43]. This study complies with the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow-chart of selection process
Fig. 2
Fig. 2
AMI-related hospitalization rate (per 100,000 population) by antidepressant use (2002–2015)
Fig. 3
Fig. 3
Survival analysis comparing AD users versus non-users
See this image and copyright information in PMC

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