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QJM Advance Access published online on January 10, 2008
QJM, doi:10.1093/qjmed/hcm153
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© The Author 2008. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Pre-existent depression in the 2 weeks before an acute coronary syndrome can be associated with delayed presentation of the heart attack

C.-K. Wong1, E.W. Tang1, P. Herbison2, B. Birmingham3, L. Barclay1 and S.Y.F. Fu1

From the 1Department of Cardiology,2Department of Preventive and Social Medicine (Statistics Division) and 3Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand

Address correspondence to Dr C.-K. Wong, MD, FRCP, FRACP, FACC, Associate Professor in Cardiology, Dunedin School of Medicine, University of Otago, Dunedin Public Hospital, New Zealand. email: cheuk-kit.wong{at}healthotago.co.nz

Received 19 September 2007 and in revised form 11 December 2007


  Abstract

Background: Depression is common among patients with acute coronary syndrome (ACS).

Aim: To examine how depression may alter outcome of ACS.

Design: Observational study on how ongoing depression influences the time delay to seeking help and its effects on subsequent treatment compliance after discharge.

Methods: Depression was measured by Beck Depression Inventory (BDI) 2 weeks prior to presentation on consecutive patients with ACS.

Results: Of the 276 patients, 81 had BDI >=10 and 195 had BDI score <10. The time from onset of the predominant symptom to seeking help tended to be longer in those with BDI >=10 than in those with BDI <10 [180 (IQR 37.5–1042.5) min vs. 120 (IQR 30–735) min, P = 0.099]. Results were similar for the 68 with ST elevation myocardial infarction (MI) [238 (IQR 49–709) min vs. 60 (IQR 20–352) min, P = 0.071]. Each point increase of BDI predicted an ~4.2% [95% confidence interval (CI) 0.4–8.0%] increase in the time duration, P = 0.029. On multivariable analysis, the effect of BDI persisted (6.0% increase in duration per each point increase in BDI, 95% CI 2.4–9.7%, P = 0.001). Among the 68 patients who had ST elevation MI, results were similar with an 8.0% (95%CI 1.7–14.7%, P = 0.013) increase in time duration for each unit increase in BDI. Results were also similar when BDI was evaluated as a dichotomous variable. Small differences were observed for subsequent treatment compliance.

Conclusion: Ongoing depression delays the presentation of ACS.


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