What is the clinical evidence from this study?

Study design: Cohort. Population: End-stage renal disease on hemodialysis (n=1798). Intervention: Poor mental health over time (MHI score ≤60) vs. Better mental health (MHI score >60). Primary outcome: All-cause mortality (Mean Survival Estimate -0.06, 95% CI -0.10, -0.03, p=<0.001).

April 6, 2012

The Association of Mental Health over Time with Cardiac Outcomes in HEMO Study Patients

Q: What are the key findings of this study?

Poor mental health over time independently decreased mean survival time from all-cause mortality by 5.8% and hastened time to first cardiac hospitalization by 7.6% in prevalent hemodialysis patients.

Q: What does this research mean for the field?

Poor mental health over time independently decreases mean survival time from all-cause mortality by 5.8% and hastens time to first cardiac hospitalization by 7.6% in prevalent hemodialysis patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

EKEa Wha KangYonsei University FPFrancis PikeIndianapolis Zoo SRSarah RamerDalhousie University

Key Result

Poor mental health over time independently decreased mean survival time from all-cause mortality by 5.8% and hastened time to first cardiac hospitalization by 7.6% in prevalent hemodialysis patients.

Study Design

Type

Cohort (n=1,798)

Multicenter

Yes

Structured PICO

Is poor mental health over time associated with increased all-cause mortality and cardiac outcomes in hemodialysis patients?

Population

Hemodialysis patients from the Hemodialysis (HEMO) study

Intervention

Poor mental health over time (defined by SF-36 mental health index score ≤60, assessed at baseline and annually)

Comparator

Better mental health (SF-36 mental health index score >60)

Outcome

All-cause mortality, cause-specific deaths, and cardiac hospitalizationshard clinical

Poor mental health over time is independently associated with increased risks of all-cause mortality and cardiac events in hemodialysis patients, highlighting the need for mental health attention in this population.

Main Result

Effect estimate: Mean Survival Estimate -0.06 (95% CI -0.10, -0.03)

p-value: p=<0.001

Limitations

The HEMO Study did not formally assess depression and anxiety.
Inclusion of only prevalent dialysis patients may have led to selection bias, rendering results not applicable to incident HD patients.
The study lacked data on insurance status, which is an important factor affecting mental health and outcomes.
Patients with poor mental health might disproportionally drop out of studies or not complete questionnaires.

Abstract

Summary Background and objectives Poor mental health over time is significantly associated with cardiovascular morbidity and mortality in the general population, which is the leading cause of death in dialysis patients. Most studies of dialysis patients, however, have investigated the relationship between baseline mental health measurements and all-cause mortality and not mental health measured longitudinally throughout a study and cause-specific mortality. Design, setting, participants, P <0.001), and they also significantly hastened time to first cardiac hospitalization by −0.08 (−0.13, −0.02; P =0.01) and composite of first cardiac hospitalization or cardiac death by −0.04 (−0.07, −0.02; P <0.001). Conclusions This study found an independent association between poor mental health over time and all-cause mortality, cardiac hospitalization, and the composite of cardiac death or cardiac hospitalization in hemodialysis patients. The results underscore the importance of attention to mental health related to cardiac complications and even death in dialysis patients.

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