Association of Depression With Mortality in Older Adults Undergoing Transcatheter or Surgical Aortic Valve Replacement

Drudi, Laura M.; Ades, Matthew; Turkdogan, Sena; Huynh, Caroline; Lauck, Sandra; Webb, John G.; Piazza, Nicolò; Martucci, Giuseppe; Langlois, Yves; Perrault, Louis P.; Asgar, Anita W.; Labinaz, Marino; Lamy, André; Noiseux, Nicolas; Peterson, Mark D.; Arora, Rakesh C.; Lindman, Brian R.; Bendayan, Melissa; Mancini, Rita; Trnkus, Amanda; Kim, Dae; Popma, Jeffrey J.; Afilalo, Jonathan

doi:10.1001/jamacardio.2017.5064

Cited by 45 publications

(43 citation statements)

References 39 publications

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“…Individuals with depression are more likely to experience social isolation, decreased work performance, anxiety, and substance use disorder, and are more likely to attempt suicide [13][14][15]. They are also more likely to develop cardiovascular disease and diabetes, and have higher all-cause mortality than individuals without depression [19,[48][49][50][51]. Productive years lost due to disability from depression are greater than those from diabetes, cardiovascular disease, and cancer [52].…”

Section: Discussionmentioning

confidence: 99%

“…The onset of depression in PLWH is multifactorial and includes neurobiological changes, HIV-related stigma, life stressors, substance use and functional health status [11,12]. Once present, depression significantly affects health and wellbeing and is associated with poor behavioral and psychosocial outcomes such as social isolation, decreased work performance, anxiety, substance use disorder, and suicide [13][14][15], as well as with poor outcomes for medical comorbidities such as diabetes, cardiovascular disease and cancer [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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Depression Prevalence, Antidepressant Treatment Status, and Association with Sustained HIV Viral Suppression Among Adults Living with HIV in Care in the United States, 2009–2014

et al. 2019

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Previous research indicates a high burden of depression among adults living with HIV and an association between depression and poor HIV clinical outcomes. National estimates of diagnosed depression, depression treatment status, and association with HIV clinical outcomes are lacking. We used 2009-2014 data from the Medical Monitoring Project to estimate diagnosed depression, antidepressant treatment status, and associations with sustained viral suppression (all viral loads in past year < 200 copies/mL). Data were obtained through interview and medical record abstraction and were weighted to account for unequal selection probabilities and non-response. Of adults receiving HIV medical care in the U.S. and prescribed ART, 27% (95% confidence interval [CI] 25-29%) had diagnosed depression during the surveillance period; the majority (65%) were prescribed antidepressants. The percentage with sustained viral suppression was highest among those without depression (72%, CI 71-73%) and lowest among those with untreated depression (66%, CI 64-69%). Compared to those without depression, those with a depression diagnosis were less likely to achieve sustained viral suppression (aPR 0.95, CI 0.93-0.97); this association held for persons with treated depression compared to no depression (aPR 0.96, CI 0.94-0.99) and untreated depression compared to no depression (aPR 0.92, CI 0.89-0.96). The burden of depression among adults living with HIV in care is high. While in our study depression was only minimally associated with a lower prevalence of sustained viral suppression, diagnosing and treating depression in persons living with HIV remains crucial in order to improve mental health and avoid other poor health outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Depression Prevalence, Antidepressant Treatment Status, and Association with Sustained HIV Viral Suppression Among Adults Living with HIV in Care in the United States, 2009–2014

et al. 2019

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“…Mood disorders are common in patients at high risk of CV disease, and depression in particular is associated with premature mortality and recurrent CV events [36], [37]. In the SAVE study of 2687 patients with established CV disease and OSA who were followed over several years, CPAP was found to significantly reduce the rates of clinically significant ‘caseness’ of depression but not of anxiety.…”

Section: Discussionmentioning

confidence: 99%

Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea: results from the sleep apnoea cardiovascular Endpoint randomised trial and meta-analysis

Zheng

You

et al. 2019

EClinicalMedicine

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Background Whether continuous positive airway pressure (CPAP) treatment can improve depression or anxiety symptoms in obstructive sleep apnoea (OSA) patients remains uncertain. Methods Secondary analysis of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial, combined with a systematic review of randomised evidence. The SAVE secondary analyses involved 2410 patients with co-existing moderate–severe OSA and established cardiovascular disease randomly allocated to CPAP treatment plus usual care or usual care alone and followed up for 3·7 (SD 1·6) years. We evaluated the effect of CPAP treatment on depression and anxiety caseness (scores ≥ 8 on the Hospital Anxiety and Depression Scale depression and anxiety subscales [HADS-D and HADS-A]) for OSA patients. Findings CPAP treatment was associated with reduced odds of depression caseness (adjusted odds ratio [OR] 0·80, 95% confidence interval [CI] 0·65–0·98, P = 0·031) compared to usual care in the SAVE trial and the treatment effect was greater in those with pre-existing depression symptoms. A systematic review of 20 randomised trials including 4255 participants confirmed a benefit of CPAP in reducing depression symptoms in OSA patients: the overall effect (standardised mean difference) was − 0·18 (95% CI − 0·24 to − 0·12). No effect of CPAP treatment on anxiety caseness was found both in patients of the SAVE study (adjusted OR 0·98, 95% CI 0·78–1·24, P = 0·89) and the systematic review. Interpretation CPAP reduces depression symptoms in patients with co-existing OSA and CVD independently of improvements in sleepiness.

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“…A 2018 prospective cohort study of 1,035 individuals ≥ 70 years old who underwent transcatheter or surgical aortic valve replacement surgery showed that baseline depression (31.5 percent of patients screened positive) was associated with mortality after 1 month (OR 2.20, 95% CI 1.18-4.10) and 12 months (OR 1.532, 95% CI 1.03-2.24). Persistent depression 6 months after the procedure was associated with a 3-fold increase in mortality at 12 months (OR 2.98, 95% CI 1.08-8.20) [39]. Therefore, active multi-disciplinary management of these patients is needed perioperatively.…”

Section: Depressionmentioning

confidence: 99%

Anesthetic management of geriatric patients

Lim

2020

Korean J Anesthesiol

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The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.

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Association of Depression With Mortality in Older Adults Undergoing Transcatheter or Surgical Aortic Valve Replacement

Abstract: One in 3 older adults undergoing TAVR or SAVR had depressive symptoms at baseline and a higher risk of short-term and midterm mortality. Patients with persistent depressive symptoms at follow-up had the highest risk of mortality.

Cited by 45 publications

References 39 publications

Depression Prevalence, Antidepressant Treatment Status, and Association with Sustained HIV Viral Suppression Among Adults Living with HIV in Care in the United States, 2009–2014

Depression Prevalence, Antidepressant Treatment Status, and Association with Sustained HIV Viral Suppression Among Adults Living with HIV in Care in the United States, 2009–2014

Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea: results from the sleep apnoea cardiovascular Endpoint randomised trial and meta-analysis

Anesthetic management of geriatric patients

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