DEPRESSION is a common symptom in elderly patients with cardiovascular disease. Now, a new study performed by researchers at the Jewish General Hospital, Montreal, Canada suggests that depression not only increases mortality over time, but is also underdiagnosed in elderly patients following surgical or transcatheter aortic valve replacement (AVR).
The study analysed data from the FRAILTY-AVR trial, which evaluated patients for frailty, cognitive impairment, and depression after AVR. The researchers assessed 1,035 patients who were aged ≥70 years and underwent transcatheter or surgical AVR at 14 centres in Canada, the USA, and France between 2011 and 2016. The occurrence of symptoms of depression in this group was measured by the 5-item Geriatric Depression Scale Short Form. In this cohort, 31.5% screened positively for depression (33.8% and 27.5% of transcatheter and surgical AVR patients, respectively), while only 8.6% had a diagnosis of depression noted in their clinical record, proving the condition to be largely underdiagnosed.
“I was quite surprised that <10% of these patients had documented depression in their clinical record, but when we administered an objective tool to screen for clinical depression, we observed that almost one-third had evidence of depressive symptoms,” explained senior author Dr Jonathan Afilalo, Jewish General Hospital.
Patients with depression had a higher predicted mortality and were more likely to have comorbidities such as hypertension, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, and cerebrovascular disease. One month after transcatheter or surgical AVR, patients with depression had more than double the mortality of patients without the condition (7.4% versus 3.0%, respectively; p=0.04); similar results were also shown after 1 year (19.0% versus 11.7%, respectively; p=0.07). The researchers hope these data will encourage physicians to consider the possibility of depression in patients throughout the follow-up process. “The message there for clinicians is not only to think about depression in the baseline evaluation of these patients, but also to ask about depressive symptoms during follow-up evaluations,” said Dr Afilalo.
The results from this analysis suggest that combatting depression, both before and after transcatheter or surgical AVR, could drastically reduce mortality in this vulnerable patient group, and that this process should begin with increased and more accurate screening. “Our hope is that, by screening patients, and consequently confirming the diagnosis in a certain proportion of those patients, that we may enable further research in improving outcomes through treatment of depression before and after [transcatheter and surgical AVR],” concluded Dr Afilalo.
