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17-01-2012 | Cardiology | Article

Depression increases risk for rehospitalization after AMI


Free abstract

MedWire News: Depression increases the risk for rehospitalization after acute myocardial infarction (AMI), US researchers say.

This may result in increased economic burden for patients and the healthcare system, report Rebecca Reese (Washington University School of Medicine, St Louis, Missouri, USA) and colleagues in Circulation: Cardiovascular Quality and Outcomes.

Their analysis included 766 participants from an Enhancing Recovery and Coronary Heart Disease ancillary study who had minor or major depression according to the Depression Interview and Structured Hamilton (DISH) questionnaire, which is based on Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) criteria.

Patients who did not meet the criteria for minor or major depression and obtained a higher score than 10 on the Beck Depression Inventory (BDI) were enrolled as controls.

Overall, 408 patients were not depressed, 195 had minor depression, and 163 had major depression. Over a mean follow-up period of 42 days, 81 (19.9%) patients who did not have depression were rehospitalized for cardiac reasons, 67 (34.4%) patients who had minor depression were rehospitalized, and 70 (42.9%) patients with major depression were rehospitalized (p<0.001).

In addition, there were 47 deaths throughout the follow-up period, of which 14 (3.4%) were in the nondepressed group, 17 (8.7%) in the minor depression group, and 16 (9.8%) in the major depression group (p=0.004).

The estimated time to first hospitalization in 25% of patients according to Kaplan-Meir analysis was 32.3 months in the nondepressed group, 11.5 months in the minor depression group, and 5.9 months in the major depression group.

Compared with patients who did not have depression, those who had major depression were 2.69-times more likely to be rehospitalized for cardiac reasons, and those with minor depression 1.99-times more likely to be rehospitalized (p<0.001).

There was no significant difference in the risk for rehospitalization between patients with major and minor depression.

In a post-hoc analysis controlling for gender, the effect of depression on rehospitalization remained significant.

Receiver-operating characteristic under the curve analysis revealed that the c-statistic for a BDI cutoff of 10 and for the DISH interview-based depression diagnosis were not significantly different.

"These findings suggest that it is not necessary to interview patients to determine whether they are at an increased risk for rehospitalization because of depression and that this determination can be made on the basis of a brief questionnaire such as the BDI," write the authors.

They add that their findings also confirm that "clinical depression actually does predict readmissions."

Reese et al conclude: "Given the high frequency and cost of hospital readmission after AMI, empirical development of risk prediction models should be a priority, and self-report depression measures should be included in them."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Piriya Mahendra

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