Association of Depression With Mortality After SAVR and TAVR
What is the prevalence of depression and its association with all-cause mortality in older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement?
The investigators conducted a preplanned analysis of the FRAILTY-AVR (Frailty Aortic Valve Replacement) prospective cohort study that included 14 centers in three countries from November 15, 2011, through April 7, 2016. Individuals ≥70 years who underwent TAVR or SAVR were enrolled. Depressive symptoms were evaluated using the Geriatric Depression Scale Short Form at baseline and follow-up. The main outcome measures were all-cause mortality at 1 and 12 months after TAVR or SAVR. Logistic regression was used to determine the association of depression with mortality after adjusting for confounders such as frailty and cognitive impairment.
Among 1,035 older adults (427 men [41.3%] and 608 women [58.7%]) with a mean (standard deviation) age of 81.4 (6.1) years, 326 (31.5%) had a positive result of screening for depression, whereas only 89 (8.6%) had depression documented in their clinical record. After adjusting for clinical and geriatric confounders, baseline depression was found to be associated with mortality at 1 month (odds ratio [OR], 2.20; 95% confidence interval [CI], 1.18-4.10) and at 12 months (OR, 1.532; 95% CI, 1.03-2.24). Persistent depression, defined as baseline depression that was still present 6 months after the procedure, was associated with a threefold increase in mortality at 12 months (OR, 2.98; 95% CI, 1.08-8.20).
The authors concluded that one in three older adults undergoing TAVR or SAVR had depressive symptoms at baseline and a higher risk of short- and mid-term mortality.
This study suggests that depression is underdiagnosed and may affect as many as one in three patients undergoing TAVR and SAVR. Furthermore, depression is associated with an increased risk of short- and mid-term mortality after adjusting for clinical and geriatric risk factors, and patients with persistent depression were at significantly higher risk than were those with resolved depression. Given the adverse prognosis associated with depression in patients undergoing TAVR and SAVR, coordinated multidisciplinary care involving cardiologists and psychiatrists is indicated to optimize management of those individuals who exhibit depressive symptoms. This may translate into improved outcomes, but additional studies are needed to determine if optimal therapy for depression in patients undergoing TAVR and SAVR actually improves outcomes.
Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Structural Heart Disease
Keywords: Cardiac Surgical Procedures, Depression, Depressive Disorder, Geriatrics, Heart Valve Diseases, Heart Valve Prosthesis, Mortality, Outcome Assessment (Health Care), Risk Factors, Secondary Prevention, Transcatheter Aortic Valve Replacement
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