Depressed Heart Surgery Patients Face Higher Mortality Rates

Physicians should pay closer attention to emotional well-being, study suggests

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WEDNESDAY, May 25, 2005 (HealthDay News) -- Heart patients suffering from depression seem to be at a higher risk of death within five years of their surgery than non-depressed patients, a new study suggests.

The findings would indicate that, besides monitoring for cholesterol and blood pressure, doctors should pay more attention to the emotional well-being of heart patients both before and after surgery, according to Duke University researchers.

In a study of nearly 5,000 heart surgery patients treated at the university's medical center, the researchers found that those who were taking anti-depressants before their heart surgery had a 10 percent lower survival rate five years after the surgery, compared to patients not taking the medicine.

"That the outcomes of patients on anti-depressants are a lot worse over time is very concerning, and shows that we need, from a clinical aspect, to be much more aggressive in treating and monitoring depression in the same way that we monitor hypertension and high cholesterol in heart surgery patients," said Dr. Glen Xiong, a resident at Duke's internal medicine-psychiatry program, and lead author of the study.

The study results were presented Wednesday at the American Psychiatric Association's annual meeting in Atlanta.

Xiong said the initial reason for undertaking the study was to see if the family of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) was linked to bleeding after heart surgery. The results were inconclusive.

But he and his colleagues were surprised to find that those patients taking SSRIs, the medicine of choice for 60 percent to 80 percent of people suffering from depression, had a higher risk of mortality, he said.

A month after surgery, the survival rates were the same for both patients taking SSRIs before their surgery and for those who did not. But five years later, the survival rate for those on SSRIs was 75.1 percent, compared to 84.9 percent for those not on the medications.

"We were expecting to find that depression would be less significant over time for people who were on SSRIs. But as time went on, the people on SSRIs were found to have a higher mortality rate," Xiong said.

Dr. Stephen Kimmel, associate professor of medicine and epidemiology at the University of Pennsylvania School of Medicine, said the similar survival rates for both groups of patients a month after surgery did not surprise him. Those early deaths were most likely due to complications from the surgery, not depression, he said.

"But this study does highlight what we have known for a while, which is that depression is associated with higher rates of morbidity and mortality in heart disease," Kimmel said.

In the analysis of 4,794 heart surgery patients, Xiong and his colleagues found that 246 patients (5.1 percent), were taking SSRIs before their operations. The group taking the antidepressants was more likely to be white, female, diabetic and suffering from hypertension than those not on the medications. However, all the patients shared the same rates of other cardiovascular risks, such as smoking or a family history of heart disease.

After adjusting the data to account for gender, ethnic background and health differences between the two groups, the researchers found that those who had taken the SSRIs still had a significantly lower survival rate.

Xiong said that, while it's clear more attention should be paid to depression in heart patients, the condition is tougher to diagnose than other risk factors, such as easily measured blood pressure readings and cholesterol levels.

"It's quite complicated. It's a lot trickier to identify and reimbursement is difficult. But we need to figure out better ways of incorporating currently available instruments that measure and treat depression and incorporate them into clinical practice," he said.

Kimmel agreed, adding that if research could show that treating depression would have an effect on lowering heart disease risks -- data that doesn't exist today -- screening for depression would likely become more widespread.

"Cholesterol testing took a long time to be established," he said, adding it took many studies showing that reducing cholesterol reduced risk for heart disease.

More information

The American Heart Association has more on the link between depression and heart disease.

SOURCES: Glen Xiong, M.D. resident, internal medicine-psychiatry program, Duke University Medical Center, Durham, N.C.; Stephen Kimmel, M.D., associate professor of medicine and epidemiology, University of Pennsylvania School of Medicine, Philadelphia; May 25, 2005, presentation, American Psychiatric Association annual meeting, Atlanta

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