The impact of depression and sex on the long-term prognosis of patients with coronary artery disease recruited for a psychosocial intervention.

OBJECTIVE

Depression is a known risk factor for mortality in CAD patients, though evidence from long-term follow-ups is limited and mixed. This secondary analysis examined whether depression, its severity, and sex interactions predict all-cause mortality in CAD patients over an extended follow-up.

METHODS

We analysed 180 CAD patients (mean age 60.6 ± 9.2 years, 26 % women) from three trials involving randomized controlled psychosocial interventions. Depression was assessed using the Hospital Anxiety and Depression Scale (HADS). Mortality data were collected from a community registry and medical records. Patients were compared as depressed (DP, HADS-D ≥ 8) vs. non-depressed (NDP, HADS-D < 8), and severely depressed (SDP, HADS-D ≥ 12) vs. not-to-moderately (NMDP, HADS-D < 12). Kaplan-Meier log-rank tests and Cox regression models, adjusted for age and left ventricular ejection fraction (LVEF), were used to assess survival. Interaction with sex was tested accordingly.

RESULTS

Mortality data were available for 175 patients (96.7 %) after a mean follow-up of 13.6 ± 2.1 years. Unadjusted comparisons showed significantly higher mortality in NDP (log-rank p = .031), but in the adjusted model only age (HR:1.08, p < .001) and LVEF (HR:0.96, p < .001) predicted mortality. SDP showed better survival than NMDP in adjusted analyses (HR:0.30, p = .048). Sex and its interaction with depression were not significant overall, but non-depressed men showed higher mortality than depressed men (log-rank p = .010).

CONCLUSION

In this long-term analysis, severely depressed CAD patients had better survival prognosis than less depressed or non-depressed patients, possibly due to behavioural changes linked to cardiovascular outcomes. These findings are preliminary and warrant further investigation.