What is the prevalence of depression and its association with all-cause mortality among older adults undergoing aortic valve replacement?
In this multicenter prospective cohort study, 326 of 1035 older adults undergoing transcatheter or surgical aortic valve replacement (31.5%) had evidence of depression at baseline and a higher risk of short-term and midterm mortality. Patients with depressive symptoms that persisted after the procedure had the highest risk of subsequent mortality.
Screening for depression may be justified during the baseline evaluation and follow-up of patients with severe aortic stenosis who are referred for aortic valve replacement.
Depression is increasingly recognized as a risk factor for adverse outcomes in cardiovascular disease. However, little is known about depression in older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement.
To determine the prevalence of depression and its association with all-cause mortality in older adults undergoing TAVR or SAVR.
Design, Setting, and Participants
This preplanned analysis of the Frailty Aortic Valve Replacement (FRAILTY-AVR) prospective cohort study included 14 centers in 3 countries from November 15, 2011, through April 7, 2016. Individuals 70 years or older who underwent TAVR or SAVR were enrolled. Depressive symptoms were evaluated using the Geriatric Depression Scale Short Form at baseline and follow-up.
Main Outcomes and Measures
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 1035 older adults (427 men [41.3%] and 608 women [58.7%]) with a mean (SD) 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% 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 3-fold increase in mortality at 12 months (OR, 2.98; 95% CI, 1.08-8.20).
Conclusions and Relevance
One in 3 older adults undergoing TAVR or SAVR had depressive symptoms at baseline and a higher risk of short-term and midterm mortality. Patients with persistent depressive symptoms at follow-up had the highest risk of mortality.
Drudi LM, Ades M, Turkdogan S, et al. Association of Depression With Mortality in Older Adults Undergoing Transcatheter or Surgical Aortic Valve Replacement. JAMA Cardiol. 2018;3(3):191–197. doi:10.1001/jamacardio.2017.5064
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