Breaking News
September 24, 2018 - Florence’s Lingering Threat: Mold – Drugs.com MedNews
September 24, 2018 - For professional baseball players, faster hand-eye coordination linked to batting performance
September 24, 2018 - Bill for later school start times is defeated, but Stanford sleep specialist isn’t
September 24, 2018 - For Heart Failure Patients, Mitral Valve Procedure Improved Outcomes
September 24, 2018 - Successful recovery from addiction means more than achieving abstinence
September 24, 2018 - New nanoplatform technology may reverse drug-resistance in renal cell carcinoma
September 24, 2018 - October 1918 marks the centenary of Spanish Flu that claimed more lives than World War I
September 24, 2018 - LGBT community reports more number of poor mental health days than general population
September 24, 2018 - New research suggests power of zebrafish as tool for cancer drug discovery
September 24, 2018 - New study finds height as possible risk factor for developing varicose veins
September 24, 2018 - Researchers compare weight loss results of online and in-person diabetes prevention program
September 24, 2018 - New HER2 PET Study Uses Affibody’s ABY-025 Tracer to Individualize Breast Cancer Treatment
September 24, 2018 - Drug combination offers more effective care for patients suffering miscarriage
September 24, 2018 - Tallness linked to varicose veins, Stanford study says
September 24, 2018 - For Heart Failure Patients, Mitral Valve Procedure Improved Outcomes
September 24, 2018 - Ecstasy drug makes octopuses more social
September 24, 2018 - Immediate compression therapy could cut risk of complications after deep-vein thrombosis
September 24, 2018 - Transcatheter mitral valve repair reduces mortality for patients with mitral regurgitation
September 24, 2018 - First intracranial aneurysm patients treated with BRAVO Flow Diverter after CE mark approval
September 24, 2018 - ‘Physicians of the mouth’? Dentists absorb the medical billing drill
September 24, 2018 - People more likely to believe those with confident tone of voice than with accent
September 24, 2018 - Harmony Biosciences Presents 5-Year Data On Pitolisant At International Narcolepsy Symposium
September 24, 2018 - Blood test may identify gestational diabetes risk in first trimester
September 24, 2018 - Height may be risk factor for varicose veins | News Center
September 24, 2018 - King’s commemorates opening of new NMR facility with one-day symposium
September 24, 2018 - Eisai receives approval for partial label change of DC Bead device for transcatheter arterial embolization
September 24, 2018 - High-resolution genomic map gives scientists unprecedented view of brain development
September 24, 2018 - Alexion announces positive results from Phase 3 PREVENT study of Soliris in patients with NMOSD
September 24, 2018 - First evaluation of benefits, harms of Alzheimer’s screening for family members of older adults
September 24, 2018 - Ancora Heart announces positive data of study evaluating AccuCinch Ventricular Repair System
September 24, 2018 - Children of mothers using cannabis may start using it at an earlier age, finds study
September 24, 2018 - Gilead Sciences plans to launch authorized generic versions of Epclusa and Harvoni in the US
September 24, 2018 - Most patients who underwent transcatheter valve replacement experience prosthesis-patient mismatch
September 24, 2018 - Lumos acquires license for LUM-201 drug that promotes secretion of growth hormone
September 24, 2018 - New study provides basis for Air Canada to change its facial hair policy for aircrew
September 24, 2018 - Infant walkers lead to thousands of emergency visits for babies
September 24, 2018 - Genes predicting person’s height may provide clues about causes of varicose veins
September 24, 2018 - EPA Plan Will Maintain Carbon Emissions From Power Plants
September 24, 2018 - Characterizing pig hippocampus could improve translational neuroscience
September 24, 2018 - Element3 Health reports social and mental engagement play key role in overall health
September 24, 2018 - Paralympic medalists support Fight for Sight’s unique virtual event
September 24, 2018 - ADCETRIS drug receives approval in Japan as frontline treatment option for Hodgkin lymphoma
September 24, 2018 - Public awareness of urological conditions found to be alarmingly low across Europe
September 24, 2018 - Fitter Folks Suffer Milder Strokes: Study
September 24, 2018 - Novel botulinum toxin compound relieves chronic pain
September 24, 2018 - CHMP recommends approval of Gilenya for treatment of multiple sclerosis in children, adolescents
September 24, 2018 - National Friendly’s private medical insurance is a hit with women living in the South East
September 24, 2018 - Academics receive prestigious awards for achievements in blood pressure research
September 24, 2018 - Obese pregnant women can restrict weight gain safely with proper nutrition guidance
September 24, 2018 - CHMP adopts positive opinion of Takeda’s ALUNBRIG for treatment of ALK+ non-small cell lung cancer
September 24, 2018 - China NMPA approves LENVIMA for treatment of unresectable hepatocellular carcinoma
September 24, 2018 - A new approach for finding Alzheimer’s treatments
September 24, 2018 - USC research uncovers previously unknown genetic risk factor for dementia
September 24, 2018 - Study examining mental health among students finds significant disparities in treatment across race
September 24, 2018 - Breakthrough discovery paves way for future test to identify drowsy drivers
September 24, 2018 - Transcatheter mitral-valve repair in patients with heart failure
September 24, 2018 - Study opens new avenues for treatment of Laing distal myopathy
September 24, 2018 - Stroke Facts | cdc.gov
September 24, 2018 - Sarcolipin tricks muscle cells into using more energy, burning fat
September 24, 2018 - Enrollment in opioid controlled substance agreement reduces primary care visits
September 24, 2018 - UTA researchers patent new smart seat cushion technology that helps prevent painful ulcers
September 24, 2018 - Second HPV-Related Primary Cancers Common in Survivors
September 24, 2018 - How a virus destabilizes the genome
September 24, 2018 - Old letters provide insight into Spanish flu pandemic horror
September 23, 2018 - Smart textile-based soft robotic exosuit helps wearers save energy and traverse difficult terrain
September 23, 2018 - New research hub to drive radical change in development and manufacturing of vaccines
September 23, 2018 - AHA: For Hispanics, Neighborhood May Be Key Factor in Heart Disease Risk
September 23, 2018 - Excessive airway nerves tied to more severe asthma symptoms, study finds
September 23, 2018 - Study highlights need to remain vigilant in maintaining key infection control processes
September 23, 2018 - Novel therapeutic strategy for blood vessel related disorders, such as cancer and retinopathy
September 23, 2018 - New naturally occurring antibiotic found effective against Mycobacterium tuberculosis
September 23, 2018 - First-in-human phase 0 study shows clinically-relevant activity of new drug in glioblastoma
September 23, 2018 - Removing tobacco product display from shops reduced number of children buying cigarettes
September 23, 2018 - Random fraction of specialized immune cells leads the charge in battling invaders
September 23, 2018 - Few minutes of sprinting exercise may be as effective as longer exercise sessions
September 23, 2018 - Researchers use neutrons to make first direct observations of water in lipid bilayers
September 23, 2018 - Researchers demonstrate pre-clinical success for universal flu vaccine in new paper
September 23, 2018 - Study reveals surprising gaps in some HIV medical providers’ knowledge of ACA
September 23, 2018 - Oxehealth secures European medical device accreditation for vital signs measurement software
September 23, 2018 - HTN Tx Intensification Common Upon Discharge in U.S. Vets
Depression Portends Death Risk After Aortic Valve Interventions

Depression Portends Death Risk After Aortic Valve Interventions

image_pdfDownload PDFimage_print

Action Points

  • Note that this observational study found that depression (as measured via survey) was associated with 1-month and 12-month mortality after aortic valve replacement.
  • Be aware that data on antidepressant use was not available.

Older adults who are depressed may be at particularly high risk of death after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), researchers said.

Baseline depression, as determined by the Geriatric Depression Scale Short Form, was associated with all-cause mortality at 1 month (7.4% versus 3.0% for non-depressed peers, adjusted OR 2.20, 95% CI 1.18-4.10) and 12 months (19.0% versus 11.7%, adjusted OR 1.532, 95% CI 1.03-2.24) after aortic valve intervention.

The association held strong whether the patient had TAVR or SAVR, Jonathan Afilalo, MD, MSc, of Jewish General Hospital in Montreal, and colleagues reported online in JAMA Cardiology. Depression persisting to 6 months post-procedure was linked to an especially high risk of mortality at 12 months (OR 2.98, 95% CI 1.08-8.20).

“The clinical implications of our findings support active screening for depression before and after aortic valve procedures to identify patients who may benefit from further psychiatric evaluation for the diagnosis and treatment of a depressive disorder. This two-tiered approach is in line with the American Heart Association recommendation to screen for depression with a brief questionnaire and, when the finding is positive, to confirm the diagnosis with a comprehensive expert evaluation,” the authors said.

“Although previous studies focusing on quality of life after TAVR and SAVR reported that mental health, on aggregate, improved in the ensuing months after the procedure, our study identified a vulnerable subset of patients in whom depressive symptoms did not improve but rather persisted or deteriorated and portended a higher risk of death.”

A total of 1,035 participants were included in this analysis of the Frailty Aortic Valve Replacement prospective cohort study, which enrolled participants age 70 years or older who were being treated for symptomatic aortic stenosis across 14 centers.

Just 8.6% had depression documented in their medical record, but 31.5% screened positive for depression in the study. Depression aside, other predictors of death at 1 year were cognitive impairment (adjusted OR 2.31, 95% CI 1.53-3.49) and physical frailty (adjusted OR 2.37, 95% CI 1.38-4.09).

“Our study suggests that depression is underdiagnosed and affects as many as one in three patients in this context,” Afilalo’s group said. The depressed suffered a heavier burden of comorbidities, were more frail, and had at higher risk of mortality to begin with, compared with non-depressed peers.

The investigators admitted that they did not systematically have patients get a formal psychiatric evaluation, so there is some possible misclassification of depression status. Additionally, it was not known who took antidepressants or who was referred to psychiatric specialists after TAVR or SAVR.

“Based on the aforementioned findings, should baseline depressive symptoms now be considered a new, common, and important mortality risk factor after TAVR? From our perspective, this may be a bridge too far,” according to an invited commentary from Amisha Patel, MD, MS, and Martin Leon, MD, both of Columbia University Medical Center in New York City.

They also saw the study’s reliance on a depression questionnaire and possible confounding by other comorbidities and geriatric syndromes as major limitations.

Moreover, the findings from Afilalo’s group do little to guide clinical practice — at least for now, Patel and Leon said: “The identification of depressive symptoms either by questionnaire or by mental health professionals is unlikely to significantly affect aortic valve replacement treatment decisions. The association with mortality is present for both surgery and TAVR, which discourages favoring either therapy in patients with depression. Perhaps the one clinical scenario of relevance is the rare patient with multiple comorbidities and depressive symptoms that are acute and severe, tilting the management in the direction of favoring palliative care.”

“Finally, to our knowledge, there is no evidence that short-term treatment of depressive symptoms in this population by any means, including pharmacotherapy, will either resolve symptoms or affect mortality,” the editorialists continued, adding that additional routine serial screening tests for depression run counter to the goals of minimalist care pathway in TAVR.

These tests “should only be embraced if clinical decision-making is enhanced or clinical outcomes can be improved,” they urged.

Afilalo, Patel, and Leon listed no relevant conflicts of interest.

Study co-authors reported several relationships with industry.

  • Reviewed by
    F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

1969-12-31T19:00:00-0500

last updated

Tagged with:

About author

Related Articles