Depressive symptoms may increase mortality risk in patients undergoing aortic valve replacement

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Prevalent depression was elicited in 222 of 657 patients (33.8%) undergoing TAVR and 104 of 378 (27.5%) undergoing SAVR.
Prevalent depression was elicited in 222 of 657 patients (33.8%) undergoing TAVR and 104 of 378 (27.5%) undergoing SAVR.

In patients undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement, approximately 1 in 3 had depressive symptoms at baseline and a higher risk of short-term and midterm mortality, according to a study published in JAMA Cardiology.

Laura M. Drudi, MD, MSc, and colleagues, conducted the Frailty Aortic Valve Replacement (FRAILTY-AVR) prospective cohort study to compare the value of various frailty scales to estimate mortality after TAVR and SAVR. The study included 14 health centers and enrolled patients from November 15, 2011, through April 7, 2016. Individuals were aged 70 years and older. Depressive symptoms in patients were evaluated using the GDS-SF at baseline and at the 6- and 12-month follow-up.

The primary end points were all-cause mortality at 1 and 12 months after the index procedure. Vital status was ascertained by contacting the patients or their family members by telephone, verifying hospital-level medical records, and linking our study database with administrative data sources. No patient was lost to or unavailable for follow-up for these end points.

The cohort consisted of 1,035 patients with a mean (SD) age of 81.4 (6.1) years, including 427 men (41.3%). At baseline, 326 patients (31.5%) had positive results of screening for depression, whereas only 89 (8.6%) had a diagnosis of depression documented in their clinical record. Prevalent depression was elicited in 222 of 657 patients (33.8%) undergoing TAVR and 104 of 378 (27.5%) undergoing SAVR.

Compared with patients without depression, those with depression were more likely to have diabetes (114 [35.0%] vs 175 [24.7%]), chronic kidney disease (154 [47.2%] vs 271 [38.2%]), hypertension (276 [84.7%] vs 543 [76.6%]), chronic obstructive pulmonary disease (74 [22.7%] vs 108 [15.2%]), cerebrovascular disease (69 [21.2%] vs 106 [15.0%]), and higher mean (SD) Society of Thoracic Surgeons–predicted risk of mortality (5.8% [4.2%] vs 5.1% [3.7%]). Moreover, compared with patients without depression, patients with depression were more likely to be frail according to the Short Physical Performance Battery (SPPB) (180 [55.2%] vs 232 [32.7%]) and the Fried scale (248 [76.1%] vs 451 [63.6%]) and to be cognitively impaired (72 [22.1%] vs 108 [15.2%]).

“Our study suggests that depression is underdiagnosed and affects as many as 1 in 3 patients in this context,” the authors concluded. “When present, depression is associated with an increased risk of short-term and midterm mortality after adjusting for clinical risk factors. The association between baseline depression and 12-month mortality was modulated by intercurrent changes in depressive symptoms, such that patients with persistent depression were at significantly higher risk than were those with resolved depression.”

Reference

Drudi LM, Ades M, Turkdogan S, et al. Association of depression with mortality in older adults undergoing transcatheter or surgical aortic valve replacement. JAMA Cardiol. 2018 Jan 17. doi: 10.1001/jamacardio.2017.5064

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