Title |
Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study
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Published in |
BMC Psychiatry, August 2016
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DOI | 10.1186/s12888-016-0986-3 |
Pubmed ID | |
Authors |
M. Elizabeth Wilcox, Elizabeth A. Freiheit, Peter Faris, David B. Hogan, Scott B. Patten, Todd Anderson, William A. Ghali, Merril Knudtson, Andrew Demchuk, Colleen J. Maxwell |
Abstract |
Depressive symptoms are prevalent in patients with coronary artery disease (CAD). It is unclear, however, how depressive symptoms change over time and the impact of these changes on long-term functional outcomes. We examined the association between different trajectories of depressive symptoms over 1 year and change in functional status over 30 months among patients undergoing coronary angiography. This was a prospective cohort study of 350 patients aged 60 and older undergoing non-emergent cardiac catheterization (October 2003-February 2007). A dynamic measure of significant depressive symptoms (i.e., Geriatric Depression Scale score 5+) capturing change over 12 months was derived that categorized patients into the following groups: (i) no clinically important depressive symptoms (at baseline, 6 and 12 months); (ii) baseline-only symptoms (at baseline but not at 6 and 12 months); (iii) new onset symptoms (not at baseline but present at either 6 or 12 months); and, (iv) persistent symptoms (at baseline and at either 6 or 12 month assessment). Primary outcomes were mean change in Older Americans Resources and Services (OARS) instrumental (IADL) and basic activities of daily living (BADL) scores (range 0-14 for each) across baseline (pre-procedure) and 6, 12, and 30 months post-procedure visits. Estimates for the symptom categories were 71 % (none), 9 % (baseline only), 8 % (new onset) and 12 % (persistent). In adjusted models, patients with persistent symptoms showed a significant decrease in mean IADL and BADL scores from baseline to 6 months (-1.32 [95 % CI -1.78 to -0.86] and -0.63 [-0.97 to -0.30], respectively) and from 12 to 30 months (-0.79 [-1.27 to -0.31] and -1.00 [-1.35 to -0.65], respectively). New onset symptoms were associated with a significant decrease in mean IADL scores at 6 months and from 6 to 12 months. Patients with no depressive symptoms showed little change in scores whereas those with baseline only symptoms showed significant improvement in mean IADL at 6 months. Patients with persistent depressive symptoms were at greatest risk for worse functional status 30 months following coronary interventions. Proactive screening and follow-up for depression in this population offers prognostic value and may facilitate the implementation of targeted interventions. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 62 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Ph. D. Student | 7 | 11% |
Student > Master | 7 | 11% |
Student > Doctoral Student | 7 | 11% |
Professor | 4 | 6% |
Researcher | 4 | 6% |
Other | 11 | 18% |
Unknown | 22 | 35% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 15 | 24% |
Nursing and Health Professions | 9 | 15% |
Psychology | 5 | 8% |
Neuroscience | 3 | 5% |
Agricultural and Biological Sciences | 2 | 3% |
Other | 5 | 8% |
Unknown | 23 | 37% |