Abstract P26: Depression Recognition and Disease-Specific Health Status in AMI Patients: Insights from the TRIUMPH Registry
Authors: Smolderen Kim G , Buchanan Donna M , Gosch Kensey , Whooley Mary , Chan Paul S , Vaccarino Viola , Shah Amit J , Ho Michael , Spertus John A 
Published: March 2022

Background:
Recognizing depression in acute myocardial infarction (AMI) offers an opportunity to treat this burdensome comorbidity, and could improve the risk stratification of AMI patients. Whether depression recognition is associated with health status after AMI is unknown.

Methods:
In the 24-center prospective TRIUMPH study, 4062 patients completed the Patient Health Questionnaire-9 (PHQ-9) during their index AMI admission and the Seattle Angina Questionnaire (SAQ) for quality of life (QOL) and angina frequency during the index admission and at 1-year. Patients were defined as depressed based on a PHQ-9 score ≥10, and depression was defined as recognized if the treating team documented any of the following in the patients' chart: depression diagnosis at discharge; anti-depressant medications administered at discharge; or referral for counseling. We examined the association between depression recognition and impaired quality of life (SAQ QOL score <75) and angina (SAQ angina frequency score <100) at 1 year using multivariable Poisson regression analyses adjusted for demographics, AMI severity, risk factors, and baseline quality of life, or angina frequency, as appropriate.

Results:
Of 4062 patients, 3303 (81.3%) were not depressed, 528 (13.0%) had unrecognized depression, and 231 (5.7%) had recognized depression. Patients with unrecognized depression were just as likely to have increased risk of 1-year adverse QOL and angina, as compared to patients with recognized depression. (Table)

Conclusion:
Depression in AMI is a comorbidity that is frequently missed in routine care. Regardless of being recognized, however, depression is associated with adverse 1-year AMI-specific health status. Although depression recognition has the potential to identify patients at risk of persistent angina and poorer QOL that might benefit from more aggressive treatment of their coronary disease, recognition in itself will not be sufficient to optimize their outcomes.

The Association Between Depression Recognition Groups and 1-Year Impaired Quality of Life/Angina

1-Year AMI-Specific Health Status

Unadjusted

Adjusted
*

N (%)
RR (95% CI)
P-Value
RR (95% CI)
P-Value

Impaired SAQ QOL

Non Depressed
369 (17.6%)
Reference

Reference

Recognized Depression
51 (38.1%)
2.31 (1.81-2.93)
<.0001
1.70 (1.31-2.20)
<.0001

Unrecognized Depression
103 (34.4%)
1.97 (1.64-2.36)
<.0001
1.54 (1.32-1.80)
<.0001

Angina

Non Depressed
436 (20.6%)
Reference

Reference

Recognized Depression
53 (39.3%)
1.98 (1.57-2.49)
<.0001
1.51 (1.18-1.95)
0.046

Unrecognized Depression
97 (32.3%)
1.54 (1.31-1.80)
<.0001
1.32 (1.14-1.53)
0.074

Abbreviations: AMI, acute myocardial infarction; SAQ, Seattle Angina Questionnaire; QOL, quality of life.

*

Covariates in the multivariable model included: age, sex, race, education, marital status, insurance status, Killip class, left ventricular systolic function, chronic heart failure, diabetes mellitus, hypercholesterolemia, hypertension, prior PCI, prior CABG, prior MI, prior CVA/TIA, current smoking, BMI, family history of CAD, ST-elevation AMI, ischemic symptoms on arrival, cancer, chronic lung disease, renal failure, and peripheral arterial disease.