Depression and prognosis following hospital admission because of acute myocardial infarction.

BACKGROUND: Whether there is an association between depression at the time of acute myocardial infarction and subsequent risk of cardiac complications and death remains controversial. Most studies of this risk factor have been limited to patients of single institutions, and this might account for the varying results. We prospectively evaluated patients admitted to 5 tertiary care and 5 community hospitals and followed them for 1 year to measure the prevalence and prognostic impact of depressive symptoms after acute myocardial infarction. METHODS: Patients were recruited for the study by trained nurse interviewers who had documented acute myocardial infarction within 2-3 days of admission. The nurses collected information from the medical records and asked study subjects to complete the Beck Depression Inventory questionnaire during their stay in hospital and using a mailed questionnaire 30 days, 6 months and 1 year later. We obtained information on vital status for patients lost to follow-up from a central death registry. RESULTS: Of the 587 study subjects, 550 (94%) completed the Beck Depression Inventory at baseline and 191 (35%) had a score of 10 or more, indicating at least mild depression. Rates of depression did not vary over the follow-up period and were similar among patients admitted to tertiary care or community hospitals. Depressed patients were more likely to undergo catheterization (57% v. 47%, 95% confidence interval [CI] around the difference 0.1%-19.6%) and were more likely to undergo percutaneous coronary intervention (32% v. 24%, 95% CI around the difference 0.1%-16.2%) within 30 days of first admission to hospital. Patients with depression on admission had higher rates of a composite of cardiac complications, including recurrent ischemia, infarction or congestive heart failure during their first stay in hospital or readmission for angina, recurrent acute myocardial infarction, congestive heart failure or arrhythmia (adjusted hazard ratio 1.4, 95% CI 1.05-1.86), compared with patients who were not depressed on admission. After 1 year, death rates were higher among patients who were depressed at admission (30 patients, 16%) compared with nondepressed patients (28 patients, 8%), although the difference was not statistically significant (hazard ratio 1.3, 95% CI 0.59-3.05). INTERPRETATION: Depressive symptoms are common after acute myocardial infarction and are associated with a slight increase in risk of in-hospital catheterization and angiography and readmission because of cardiac complications. Death was infrequent, with no statistically significant difference between the 2 groups.

Quality of life after acute myocardial infarction among patients treated at sites with and without on-site availability of angiography.

BACKGROUND: Previous studies have compared the treatment and outcome of patients with acute myocardial infarction (AMI) admitted at sites with and without availability of angiography. Although mortality rates do not differ, it is unknown if quality of life (QOL) and functional status differ. METHODS: We measured QOL and functional status in patients with AMI treated within Québec at 5 sites with (n = 253) and 5 sites without (n = 334) angiography. RESULTS: At admission, clinical characteristics, complication rates, and baseline measures of QOL and functional status were similar at sites with and without angiography. During hospitalization, patients treated at sites with angiography were more likely to undergo an invasive cardiac procedure than patients admitted at sites without angiography (angiography, 63% vs 26%; percutaneous transluminal coronary angioplasty, 33% vs 13%; and coronary artery bypass graft, 12% vs 5%). At 30 days and 6 months after AMI, QOL was slightly superior at sites with angiography, but by 1 year, most measures of QOL were back to baseline at both types of sites and were similar between the 2 groups. At 6 months, most standard health-related QOL components were similar; only physical and emotional role limitations were higher at sites with angiography. Return to work occurred earlier (at 30 days, 23% vs 12%), and a lower proportion of patients was readmitted for angina (within 1 year after AMI, 12% vs 18%) at sites with angiography. CONCLUSIONS: In the early post-AMI period, the QOL of patients admitted at sites with angiography was higher than that of patients admitted at sites without angiography. However, by 1 year, the QOL and functional status of patients was similar in both groups. Differences in QOL were greatest when differences in treatment were greatest, lending support to a positive albeit small association between an early invasive approach to post-AMI care and improved QOL.