Key result
Continuative use of antidepressants prior to acute myocardial infarction was independently associated with a significantly higher risk of mortality (adj OR 1.75).
Why the study?
Depression is associated with increased cardiovascular risk and mortality with comorbidities, but whether continuative antidepressant use before acute myocardial infarction affects subsequent mortality was unclear.
Does continuative use of antidepressants prior to acute myocardial infarction increase mortality in AMI survivors?
Cohort (n=3,985)
Does continuative use of antidepressants prior to acute myocardial infarction increase mortality in AMI survivors?
Odds Ratio: 1.75 (95% CI 1.4–2.19)
Absolute Event Rate: 50.2% vs 37.3%
p-value: p=<0.01
Continuative use of antidepressants prior to acute myocardial infarction is associated with significantly higher long-term mortality, suggesting these patients represent a high-risk subgroup requiring careful monitoring.
BACKGROUND: Depression has been associated with a higher risk of cardiovascular events and a higher mortality in patients with one or more comorbidities. This study investigated whether continuative use of antidepressants (ADs), considered as a proxy of a state of depression, prior to acute myocardial infarction (AMI) is associated with a higher mortality afterwards. The outcome to assess was mortality by AD use. METHODS: A retrospective cohort study was conducted in the Veneto Region on hospital discharge records with a primary diagnosis of AMI in 2002-2015. Subsequent deaths were ascertained from mortality records. Drug purchases were used to identify AD users. A descriptive analysis was conducted on patients' demographics and clinical data. Survival after discharge was assessed with a Kaplan-Meier survival analysis and Cox's multiple regression model. RESULTS: Among 3985 hospital discharge records considered, 349 (8.8%) patients were classified as 'AD users'. The mean AMI-related hospitalization rate was 164.8/100,000 population/year, and declined significantly from 204.9 in 2002 to 130.0 in 2015, but only for AD users (- 40.4%). The mean overall follow-up was 4.6 ± 4.1 years. Overall, 523 patients (13.1%) died within 30 days of their AMI. The remainder survived a mean 5.3 ± 4.0 years. After adjusting for potential confounders, use of antidepressants was independently associated with mortality (adj OR = 1.75, 95% CI: 1.40-2.19). CONCLUSIONS: Our findings show that AD users hospitalized for AMI have a worse prognosis in terms of mortality. The use of routinely-available records can prove an efficient way to monitor trends in the state of health of specific subpopulations, enabling the early identification of AMI survivors with a history of antidepressant use.
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Cocchio et al. (2019) conducted a cohort in Acute myocardial infarction (n=3,985). Antidepressant use vs. Non-users of antidepressants was evaluated on Mortality (adj OR 1.75, 95% CI 1.40-2.19, p=<0.01). Continuative use of antidepressants prior to acute myocardial infarction was independently associated with a significantly higher risk of mortality (adj OR 1.75).
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