Depressive Symptoms and First Hospitalization/All-Cause Mortality in the Emory Cardiovascular Biobank Longitudinal Database (2004-2018) Restricted; Files & ToC

Ramineni Suneela (Fall 2023)

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Objective: The goal of this study was to describe the association between depressive symptoms and first hospitalization for reasons related to cardiovascular disease or death among patients at Emory University Hospital and Grady Hospital in Atlanta, GA from 2004 to 2018. Possible risk factors for first hospitalization or death were evaluated.

Design: The data were prospectively collected from date of enrollment. Planned follow-up time was 5 years. The primary endpoint was time to first hospitalization due to re-vascularization, heart failure, or other reasons, or all-cause death.

Methods: Demographic data and other patient characteristics were collected at baseline. During enrollment, patients were asked to complete an eight-question instrument that aimed to quantify their depressive symptoms and mental health condition on a scale from 1 to 4. These responses to the eight questions were added. The patients were then divided into three groups based on this sum: the first group consisted of patients who got a sum of 0, the low depressive symptoms group consisted of patients who had a sum between 1 and 12, and the high depressive symptoms group had a sum between 12 and 24. Competing-risk analysis was then employed to assess the association between depressive symptoms and time to first hospitalization for re-vascularization, heart failure and all other cardiovascular reasons or death, controlling for demographic and other baseline variables.

Results: The sample consisted of 5200 patients, 37.6% of whom were female. The mean ± standard deviation for age was 61.9 ± 13.4 years (range: 18-99). The majority of the patients were white (71.9%), followed by black (23.6%). Assessment of comorbidities was also done at baseline: hypertension (70.1%), hyperlipidemia (63.1%), diabetes (33.4%), BMI (29.8 ± 6.6 kg/m2) and previous myocardial infarction (30.1%). Age and employment status were associated with death and first hospitalization for re-vascularization, heart failure and other reasons. Patients who had high depressive symptoms had a higher rate of first hospitalization due to heart failure and all-cause death. In particular, the hazard ratio comparing high and no depressive symptom groups was 1.69, 95% CI: (1.23, 2.30) for heart failure and 2.86, 95% CI: (1.90, 4.30) for all-cause death.

Conclusion: Patients who have cardiovascular disease with depressive symptoms have a higher rate of hospitalization for heart failure or death. A follow-up study is recommended to further confirm and understand this preliminary finding.

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