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Elevated depression symptoms predict long-term cardiovascular mortality in patients with atrial fibrillation and heart failure
Circulation, 07/02/09

Frasure-Smith N et al. – Elevated depression symptoms are related to cardiovascular mortality even after adjustment for other prognostic indicators in pts with comorbid atrial fibrillation (AF) and congestive heart failure (CHF) who receive optimized treatment. Unmarried pts are also at increased risk. Mechanisms and treatment options deserve additional study.

Methods

Substudy of the AF-CHF Trial of rate- versus rhythm-control strategies
Investigation of whether depression predicts long-term cardiovascular mortality in pts with left ventricular ejection fraction ≤35%, CHF symptoms, and AF history who receive optimal medical care
Assessment of depression symptoms (Beck Depression Inventory-II) in 974 pts (833 men)
Cox proportional hazards models adjustments for prognostic factors: age, marital status, CHF cause, creatinine level, left ventricular ejection fraction, paroxysmal AF, previous AF hospitalization, previous electrical conversion, and baseline medications)

Results

On adjustment elevated depression scores significantly predicted cardiovascular mortality (primary outcome), arrhythmic death, and all-cause mortality
Elevated depression symptom scores (Beck Depression Inventory-II ≥14) in 32.0% of pts
Mean follow-up of 39 mo: 246 cardiovascular deaths (111 presumed arrhythmic; 302 all-cause deaths)
Risks associated with depression and marital status were additive; highest risk in depressed unmarried pts

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