Depression treatment after myocardial infarction and long-term risk of subsequent cardiovascular events and mortality: A randomized controlled trial

Marij Zuidersma*, Henk Jan Conradi, Joost P. van Melle, Johan Ormel, Peter de Jonge

*Corresponding author for this work

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Abstract

Objective: Evaluating the effects of implementing an antidepressant treatment strategy in depressed myocardial infarction (MI)-patients on long-term cardiovascular outcomes and all-cause mortality.

Methods: MI-patients were evaluated for the presence of a diagnosis of post-MI depression at 3, 6, 9 and. 12 month's after hospitalization for MI. A total of 331. depressed MI-patients were randomized to intervention or care-as-usual (CAU). Patients randomized to the intervention were offered several antidepressant treatment options including pharmacological and non-pharmacological therapy. Patients randomized to CAU were not given feedback about their. depression status. All patients were free to seek depression treatment outside the study, which was monitored. The primary outcome was a combined endpoint of cardiovascular events and cardiac mortality between randomization and 8 years later. All-cause mortality was evaluated as secondary endpoint.

Results: The intervention did not reduce the risk of the primary outcome (HR: 0.97 (95% CI: 0.67-1.40) n=330) or all-cause mortality (HR: 0.74 (95% CI: 0.41-1.33) n=330). Regardless of randomization status, patients who received depression treatment (n=168) had reduced all-cause mortality rates rates compared to those who did not receive treatment (n=143, HR: 0.52 (95% CI: 0.28-0.97)).

Conclusion: Implementing an antidepressant treatment strategy did not reduce, the risk of cardiovascular morbidity and mortality compared to usual care. Receiving depression treatment increased survival. It remains unclear whether this represents a direct treatment effect or is due to unmeasured factors that relate to both receiving depression treatment and mortality, such as patients' intrinsic motivation to care for their health. (C) 2012 Elsevier Inc. All lights reserved.

Original languageEnglish
Pages (from-to)25-30
Number of pages6
JournalJournal of Psychosomatic Research
Volume74
Issue number1
DOIs
Publication statusPublished - Jan-2013

Keywords

  • Cardiovascular prognosis
  • Depression treatment
  • Myocardial infarction
  • ACUTE CORONARY SYNDROME
  • TREATMENT-RESISTANT
  • ENHANCING RECOVERY
  • MIND-IT
  • DISEASE
  • INTERVENTION
  • ASSOCIATION
  • PROGNOSIS
  • ENRICHD
  • CARE

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