scholarly journals Impact of pre-admission depression on mortality following myocardial infarction

2017 ◽  
Vol 210 (5) ◽  
pp. 356-361 ◽  
Author(s):  
Jens Sundbøll ◽  
Morten Schmidt ◽  
Kasper Adelborg ◽  
Lars Pedersen ◽  
Hans Erik Bøtker ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cox Regression ◽  
Population Based ◽  
Prognostic Impact ◽  
Depression Diagnosis ◽  
All Cause Mortality ◽  
History Of ◽  
Rate Ratios ◽  
First Time ◽  
History Of Depression

BackgroundThe prognostic impact of previous depression on myocardial infarction survival remains poorly understood.AimsTo examine the association between depression and all-cause mortality following myocardial infarction.MethodUsing Danish medical registries, we conducted a nationwide population-based cohort study. We included all patients with first-time myocardial infarction (1995–2014) and identified previous depression as either a depression diagnosis or use of antidepressants. We used Cox regression to compute adjusted mortality rate ratios (aMRRs) with 95% confidence intervals.ResultsWe identified 170 771 patients with first-time myocardial infarction. Patients with myocardial infarction and a previous depression diagnosis had higher 19-year mortality risks (87% v. 78%). The overall aMRR was 1.11 (95% CI 1.07–1.15) increasing to 1.22 (95% CI 1.17–1.27) when including use of antidepressants in the depression definition.ConclusionsA history of depression was associated with a moderately increased all-cause mortality following myocardial infarction.

scholarly journals Readmissions for Depression and Suicide Attempt following Stroke and Myocardial Infarction

2020 ◽  
Vol 10 (2) ◽  
pp. 94-104
Author(s):  
Laura K. Stein ◽  
Alana Kornspun ◽  
John Erdman ◽  
Mandip S. Dhamoon
Keyword(s):  
Myocardial Infarction ◽  
Suicide Attempt ◽  
Cox Regression ◽  
Vascular Events ◽  
Discharge Home ◽  
Increased Risk ◽  
Significant Difference ◽  
History Of ◽  
Nationally Representative ◽  
History Of Depression

Background and Purpose: Rates of depression after ischemic stroke (IS) and myocardial infarction (MI) are significantly higher than in the general population and associated with morbidity and mortality. There is a lack of nationally representative data comparing depression and suicide attempt (SA) after these distinct ischemic vascular events. Methods: The 2013 Nationwide Readmissions Database contains >14 million US admissions for all payers and the uninsured. Using International Classification of Disease, 9th Revision, Clinical Modification Codes, we identified index admission with IS (n = 434,495) or MI (n = 539,550) and readmission for depression or SA. We calculated weighted frequencies of readmission. We performed adjusted Cox regression to calculate hazard ratio (HR) for readmission for depression and SA up to 1 year following IS versus MI. Analyses were stratified by discharge home versus elsewhere. Results: Weighted depression readmission rates were higher at 30, 60, and 90 days in patients with IS versus MI (0.04%, 0.09%, 0.12% vs. 0.03%, 0.05%, 0.07%, respectively). There was no significant difference in SA readmissions between groups. The adjusted HR for readmission due to depression was 1.49 for IS versus MI (95% CI 1.25–1.79, p < 0.0001). History of depression (HR 3.70 [3.07–4.46]), alcoholism (2.04 [1.34–3.09]), and smoking (1.38 [1.15–1.64]) were associated with increased risk of depression readmission. Age >70 years (0.46 [0.37–0.56]) and discharge home (0.69 [0.57–0.83]) were associated with reduced hazards of readmission due to depression. Conclusions: IS was associated with greater hazard of readmission due to depression compared to MI. Patients with a history of depression, smoking, and alcoholism were more likely to be readmitted with depression, while advanced age and discharge home were protective. It is unclear to what extent differences in type of ischemic tissue damage and disability contribute, and further investigation is warranted.

Abstract MP79: Pre-Admission History of Depression and Mortality After Acute Myocardial Infarction

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Elena Salmoirago-Blotcher ◽  
Darleen Lessard ◽  
Joel Gore ◽  
Robert Goldberg
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Hospital Treatment ◽  
Depression Treatment ◽  
Coronary Risk Factors ◽  
Post Discharge ◽  
All Cause Mortality ◽  
History Of ◽  
History Of Depression

Background: Whether a diagnosis of depression after developing an acute myocardial infarction (AMI) is linked to a worse prognosis remains a matter of debate after several RCTs of interventions to treat post-AMI depression have yielded negative results. A possible explanation is that depressive symptoms after AMI may be part of the normal adjustment to an adverse life event. A pre-admission history of depression could better identify patients who may derive the most benefit from depression treatment. The objective of this study was to evaluate whether a pre-admission history of depression was associated with a worse post-discharge prognosis among patients with AMI. Methods: This was a secondary analysis conducted among patients included (biennial basis between 1999-2009) in the Worcester Heart Attack Study, an ongoing epidemiologic study examining long-term trends in the clinical outcomes of AMI among residents of the Worcester, MA metropolitan area. The exposure was defined as a physician-recorded diagnosis of depression preceding the index hospitalization for AMI based on the review of hospital medical records (MR). The outcome was all-cause death rates in-hospital and 1-year post discharge. Information regarding demographics, medical history, in-hospital treatment, and discharge status was abstracted from the MR by trained study physicians and nurses. Survival status after discharge was obtained from the MR and from death certificates. Univariate and multivariate logistic regression models were used to assess associations between depression and the outcome. Results: This analysis included 5,068 patients (mean age 70 years, 44% women). Approximately 16% of patients had a history of depression pre-admission. No significant differences were found between patients with and without a history of depression with regard to in-hospital mortality (11.5% vs. 9.9%; unadjusted OR=1.18; 95% CI: 0.95, 1.48). At 1 year after discharge all-cause mortality was significantly higher among patients with a pre-admission history of depression (27.5% vs. 18.2%; unadjusted OR=1.71; 95% CI: 1.44, 2.02). While the association between history of depression and in-hospital mortality was largely explained by confounding, the association with 1 year mortality remained significant even after adjustment for demographics, coronary risk factors, co-morbidities, clinical characteristics and medications at discharge (OR=1.57; CI: 1.24, 1.98). Conclusions: In this community-based cohort of patients hospitalized with AMI at different hospitals in central MA, a pre-admission history of depression was an independent predictor of all-cause mortality 1 year after MI. Documentation of a history of depression in the medical record could be a simple tool for cardiologists and primary care physicians to identify high-risk patients who may benefit from depression treatment.

scholarly journals Autism risk following antidepressant medication during pregnancy

2017 ◽  
Vol 47 (16) ◽  
pp. 2787-2796 ◽  
Author(s):  
A. Viktorin ◽  
R. Uher ◽  
A. Reichenberg ◽  
S. Z. Levine ◽  
S. Sandin
Keyword(s):  
Cox Regression ◽  
Population Sample ◽  
Antidepressant Drugs ◽  
Antidepressant Medication ◽  
Population Based ◽  
Autism Spectrum ◽  
Relative Risks ◽  
Increased Risk ◽  
History Of ◽  
History Of Depression

BackgroundPrevious studies have examined if maternal antidepressant medication during pregnancy increase the risk of autism spectrum disorder (ASD) in the offspring, but the results have been conflicting.MethodsIn a population-based cohort of 179 007 children born in 2006 and 2007 and followed through 2014 when aged 7 and 8, we estimated relative risks (RRs) of ASD and 95% confidence intervals (CIs) from Cox regression in children exposed to any antidepressant medication during pregnancy, and nine specific antidepressant drugs. Analyses were adjusted for potential confounders and were conducted in the full population sample, and in a clinically relevant sub-sample of mothers with at least one diagnosis of depression or anxiety during life.ResultsThe adjusted RR of ASD in children of mothers who used antidepressant medication during pregnancy was estimated at 1.23 (95% CI 0.96–1.57), and at 1.07 (95% CI 0.80–1.43) in women with a history of depression or anxiety. Analyses of specific antidepressants initially revealed increased RRs of offspring ASD confined to citalopram and escitalopram (RR: 1.47; 95% CI 0.92–2.35) and clomipramine (RR: 2.86; 95% CI 1.04–7.82).ConclusionMedication with antidepressants during pregnancy does not appear to be causally associated with an increased risk of ASD in the offspring. Instead, the results suggest that the association is explained by factors related to the underlying susceptibility to psychiatric disorders. Based on these findings, the risk of ASD in the offspring should not be a consideration to withhold treatment with commonly used antidepressant drugs from pregnant women.

P2659Difference of prognostic impact of Killip classification in ACS patients with or without hemodialysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Takasaki ◽  
T Kurita ◽  
J Masuda ◽  
K Dohi ◽  
K Hoshino ◽  
...  
Keyword(s):  
Cox Regression ◽  
Chronic Phase ◽  
Prognostic Impact ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
History Of ◽  
Artery Disease

Abstract Background Cardiovascular deaths are more frequently in hemodialysis (HD) patients compared to general population. However, difference of prognosis of acute coronary syndrome (ACS) patients with or without HD were not well evaluated. Purpose The purpose of this study was to evaluate the clinical and prognostic characteristics of ACS patients with HD compared to that of ACS patients without HD. Methods We investigated 3427 ACS patients including 63 HD and 3364 non-HD patients between 2013 and 2017 using date from Mie ACS registry, a retrospective and multicenter registry. The primary outcome was defined as all-cause mortality. Results HD patients showed significantly higher prevalence of diabetes mellitus, past treatment of coronary artery disease, history of myocardial infarction and Killip ≥2 compared to non-HD patients (p<0.05, respectively). During the follow-up periods (median 719 days), 425 (12.4%) patients experienced all-cause death. HD patients demonstrated the higher all-cause mortality rate compared to that of non-HD patients during the follow-up (11.9% versus 38.1%, p<0.001, chi square). Kaplan Meier survival curves demonstrated that HD and non-HD patients with Killip 1 showed similar 30-day mortality, and Killip ≥2 patients also showed similar prognosis (Left side of figure). On the other hand, all cause mortality at 2 years were higher in Killip 1 HD patients compared to Killip 1 non-HD patients and similar between Killip 1 HD patients and Killip ≥2 non-HD patients in the 30 days landmark analysis (Right side of figure). In addition, cox regression analyses for all cause mortality demonstrated that HD was a strongest independent prognostic factor not of 30-day mortality but of after 30-day mortality with hazard ratio of 4.09 (95% confidential interval: 2.32–7.21, p<0.001). Figure 1 Conclusion Careful management are required in chronic phase for ACS patients with HD even in Killip 1 classification.

scholarly journals Impact of Elevated Systolic Arterial Pulmonary Pressure on Short and Long Term All-Cause Mortality After Acute Myocardial Infarction in the Elderly

2021 ◽  
Author(s):  
Salim Barywani ◽  
Magnus C Johansson ◽  
Silvana kontogeorgos ◽  
Zacharias Mandalenakis ◽  
Per-Olof Hansson
Keyword(s):  
Myocardial Infarction ◽  
Cox Regression ◽  
The Elderly ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systolic Pulmonary Artery Pressure ◽  
Prognostic Impact ◽  
All Cause Mortality ◽  
Acute Mi ◽  
The Impact

Abstract Background: Reduced left ventricular ejection fraction (LVEF) is associated with increased mortality after myocardial infarction (MI). However, the prognostic impact of elevated systolic pulmonary artery pressure (sPAP) in the elderly patients with MI is not well studied. Purpose: We aimed to study the impact of elevated sPAP on one- and five-year all-cause mortality after acute MI in patients 80 years of age and older.Methods: Of a total number of 353 patients(≥80 years old)that were hospitalized with acute coronary syndrome, 162 patients presenting with acute MI and with available data of sPAP on echocardiography were included and followed-up for 5 years. The survival analyses were performed using Cox-Regression models adjusted for conventional risk factors including LVEF.Results: Altogether 65 of 162 patients (40%) had ST-segment elevation MI, and 121 (75%) of patients were treated with percutaneous coronary intervention in the acute phase. Echocardiography during the admission revealed that 78 patients (48%) had a LVEF ≤ 45% and 65 patients (40%) had a sPAP ≥40 mmHg. After one and five years of follow-up, 23% (n=33) and 53% (n=86) of patients died, respectively. A multivariable Cox-Regression analysis showed that the elevated sPAP was an independent predictor of increased mortality in both one and five years after acute MI; HR of 3.4(95%, CI 1.4-8.2, P 0.006) and HR of 2.0(95%, CI 1.2-3.4, P 0.004) respectively, whereas LVEF did not show any statistically significant impact, neither on one- nor on five-year mortality (HR 1.4, 95% CI 0.8-2.4, p=0.158) and (HR 1.3, 95% CI 0.6-2.9, p=0.469), respectively.Conclusion:Elevated sPAP is an independent risk factor for one- and five-year all-cause mortality in patients with acute MI and it seems to be a better prognostic factor for death than LVEF. The risk of all-cause mortality in MI patients increased with increasing sPAP.

scholarly journals Legumain is a predictor of all-cause mortality and potential therapeutic target in acute myocardial infarction

2020 ◽  
Vol 11 (11) ◽  
Author(s):  
Hui Yang ◽  
Yuhu He ◽  
Pu Zou ◽  
Yilei Hu ◽  
Xuping Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cox Regression ◽  
Interquartile Range ◽  
Prognostic Impact ◽  
Healthy Controls ◽  
Operating Characteristics ◽  
Cox Regression Analysis ◽  
All Cause Mortality ◽  
Ecm Degradation

AbstractThe prognostic impact of extracellular matrix (ECM) modulation and its regulatory mechanism post-acute myocardial infarction (AMI), require further clarification. Herein, we explore the predictive role of legumain—which showed the ability in ECM degradation—in an AMI patient cohort and investigate the underlying mechanisms. A total of 212 AMI patients and 323 healthy controls were enrolled in the study. Moreover, AMI was induced in mice by permanent ligation of the left anterior descending artery and fibroblasts were adopted for mechanism analysis. Based on the cut-off value for the receiver-operating characteristics curve, AMI patients were stratified into low (n = 168) and high (n = 44) plasma legumain concentration (PLG) groups. However, PLG was significantly higher in AMI patients than that in the healthy controls (median 5.9 μg/L [interquartile range: 4.2–9.3 μg/L] vs. median 4.4 μg/L [interquartile range: 3.2–6.1 μg/L], P < 0.001). All-cause mortality was significantly higher in the high PLG group compared to that in the low PLG group (median follow-up period, 39.2 months; 31.8% vs. 12.5%; P = 0.002). Multivariate Cox regression analysis showed that high PLG was associated with increased all-cause mortality after adjusting for clinical confounders (HR = 3.1, 95% confidence interval (CI) = 1.4–7.0, P = 0.005). In accordance with the clinical observations, legumain concentration was also increased in peripheral blood, and infarcted cardiac tissue from experimental AMI mice. Pharmacological blockade of legumain with RR-11a, improved cardiac function, decreased cardiac rupture rate, and attenuated left chamber dilation and wall thinning post-AMI. Hence, plasma legumain concentration is of prognostic value in AMI patients. Moreover, legumain aggravates cardiac remodelling through promoting ECM degradation which occurs, at least partially, via activation of the MMP-2 pathway.

Prognostic impact of SYNTAX II score in patients with cardiogenic shock complicating ST-elevation myocardial infarction: analysis of an 10-year all-comers registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Juskova ◽  
P Tasende Rey ◽  
B Cid Alvarez ◽  
B Alvarez Alvarez ◽  
J.M Garcia Acuna ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Prognostic Information ◽  
St Segment Elevation ◽  
All Cause Mortality

Abstract Background The SYNTAX II score (SS-II) can predict 4-year outcomes in patients with complex coronary artery disease and ST-segment elevation myocardial infarction (STEMI). Nonetheless, the prognostic value of SS-II for a cardiogenic shock (CS) in the setting of STEMI has not been assessed. Purpose This study aimed to investigate the predictive impact of SS-II in patients with CS complicating STEMI undergoing primary percutaneous coronary intervention, and whether SS-II adds prognostic information to predict major adverse cardiac events (MACE) and all-cause death in this population. Methods This prospective cohort study included 1965 consecutive patients with STEMI who underwent primary-PCI between January 2008 and December 2017. The cohort of patients with CS (n=153) was identified and divided into three groups based on SS-II tertiles [SS-II low tertile &lt;38 (n=51), ≥38 SS-II intermediate tertile &lt;47 (n=51), and SS-II high tertile ≥48 (n=51)]. Results Amongst the cohort of patients with CS mean age was 68.4±14.0 years, 69.2% were male and 51.6% presented with anterior STEMI (mean SSII was 45.1±14). In-hospital mortality was significantly higher in the high SS-II tertile (85.7% vs. 38.9% vs 24.4%, p≤0.001) compared with SS-II intermediate and low tertiles. During follow-up (median 2.5 years), SS-II was positively correlated with MACE (89.3% (high SS-II) vs. 52.8% (int SS-II) vs. 42.2% (low SS-II), p≤0.001), and with all-cause mortality (89.3% vs 44.4% vs 26.7%, p≤0.001). The SS-II was also an independent predictor of MACE (HR=1.042, 95% CI: 1.020–1.063, p=0.000) and all-cause mortality during follow-up (HR=1.056, 95% CI: 1.033–1.079, p=0.000) Conclusion In a real-world cohort of patients with STEMI related CS, the SS-II added important prognostic information, being an independent predictor of MACE and all-cause mortality during follow-up. Image 1 Funding Acknowledgement Type of funding source: None

scholarly journals Association between glaucoma surgery and all-cause and cause-specific mortality among elderly patients with glaucoma: a nationwide population-based cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sang Yeop Lee ◽  
Hun Lee ◽  
Ji Sung Lee ◽  
Sol Ah Han ◽  
Yoon Jeon Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
Elderly Patients ◽  
Cox Regression ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Population Based ◽  
Angle Closure ◽  
Charlson Comorbidity Index Score ◽  
All Cause Mortality ◽  
Specific Mortality

AbstractThis population-based, retrospective cohort study aimed to evaluate the association between glaucoma surgery and all-cause and cause-specific mortality among Korean elderly patients with glaucoma. A total of 16210 elderly patients (aged ≥ 60 years) diagnosed with glaucoma between 2003 and 2012 were included, and their insurance data were analyzed. The participants were categorized into a glaucoma surgery cohort (n = 487), which included individuals who had diagnostic codes for open angle glaucoma (OAG) or angle closure glaucoma (ACG) and codes for glaucoma surgery, and a glaucoma diagnosis cohort (n = 15,723), which included patients who had codes for OAG and ACG but not for glaucoma surgery. Sociodemographic factors, Charlson Comorbidity Index score, and ocular comorbidities were included as covariates. Cox regression models were used to assess the association between glaucoma surgery and mortality. The incidence of all-cause mortality was 34.76/1,000 person-years and 27.88/1,000 person-years in the glaucoma surgery and diagnosis groups, respectively. The adjusted hazard ratio (HR) for all-cause mortality associated with glaucoma surgery was 1.31 (95% confidence interval [CI], 1.05–1.62, P = 0.014). The adjusted HR for mortality due to a neurologic cause was significant (HR = 2.66, 95% CI 1.18–6.00, P = 0.018). The adjusted HRs for mortality due to cancer (HR = 2.03, 95% CI 1.07–3.83, P = 0.029) and accident or trauma (HR = 4.00, 95% CI 1.55–10.34, P = 0.004) associated with glaucoma surgery for ACG were significant as well. Glaucoma surgery was associated with an increase of mortality in elderly patients with glaucoma. In particular, the risk of mortality associated with glaucoma surgery due to neurologic causes was significant.

458Real world persistence with direct oral anticoagulants in anticoagulation naive patients with atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Denas ◽  
G Costa ◽  
E Ferroni ◽  
N Gennaro ◽  
U Fedeli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Cox Regression ◽  
Anatomical Therapeutic Chemical ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Female Gender ◽  
Population Based ◽  
Real World Data

Abstract Introduction Anticoagulation therapy is central for the management of stroke in patients with non-valvular atrial fibrillation (NVAF). Persistence with oral anticoagulation is essential to prevent thromboembolic complications. Purpose To assess persistence levels of DOACs and look for possible predictors of treatment discontinuity in NVAF patients. Methods We performed a population-based retrospective cohort study in the Veneto Region (north-eastern Italy, about 5 million inhabitants) using the regional health system databases. Naïve patients initiating direct oral anticoagulants (DOACs) for stroke prevention in NVAF from July 2013 to September 2017 were included in the study. Patients were identified using Anatomical Therapeutic Chemical (ATC) codes, excluding other indications for anticoagulation therapy using ICD-9CM codes. Treatment persistence was defined as the time from initiation to discontinuation of the therapy. Baseline characteristics and comorbidities associated to the persistence of therapy with DOACs were explored by means of Kaplan-Meier curves and assessed through Cox regression. Results Overall, 17920 patients initiated anticoagulation with DOACs in the study period. Most patients were older than 74 years old, while gender was almost equally represented. Comorbidities included hypertension (72%), diabetes mellitus (17%), congestive heart failure (9%), previous stroke/TIA (20%), and prior myocardial infarction (2%). After one year, the persistence to anticoagulation treatment was 82.7%, while the persistence to DOAC treatment was 72.9% with about 10% of the discontinuations being due to switch to VKAs. On multivariate analysis, factors negatively affecting persistence were female gender, younger age (<65 years), renal disease and history of bleeding. Conversely, persistence was better in patients with hypertension, previous cerebral ischemic events, and previous acute myocardial infarction. Persistence to DOAC therapy Conclusion This real-world data show that within 12 months, one out of four anticoagulation-naïve patients stop DOACs, while one out of five patients stop anticoagulation. Efforts should be made to correct modifiable predictors and intensify patient education.

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