Grace SL et al. (2005) Effect of depression on five-year mortality after an acute coronary syndrome. Am J Cardiol [doi:10.1016/j.amjcard.2005.06.052]

Depression during hospitalization following acute coronary syndromes is known to be related to long-term mortality. Most studies showing this relationship rely on a single measure of depression taken at admission, and the effect of a history of depression and persistent depressive symptomatology on mortality is unclear.

This longitudinal observational study included 750 patients with unstable angina pectoris or myocardial infarction admitted to one of 12 coronary care units. Assessments included analysis of sociodemographic and clinical data, and of the BECK DEPRESSION INVENTORY (BDI); findings were linked to 5-year all-cause mortality. Overall, 23.2% of participants reported a history of a depressed mood for >2 weeks, with 14% reporting persistent depression. BDI scores were elevated at hospitalization in 31.3% of participants. After adjusting for various prognostic indicators, depressive symptomatology during hospitalization was significantly predictive of mortality within 5 years, but depressive history was not. High BDI scores (≥10) were associated with hazard ratios ranging from 1.9 at 2 years to 1.53 at 5 years compared with lower scores (<10).

These data suggest that depressive symptoms on hospitalization for cardiac events, but not before, are an important prognostic indicator for many years following a cardiac event. Early identification and treatment of elevated depressive symptoms might not only improve quality of life, but might also decrease the risk of mortality.