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Original Investigation
March 2018

Association of Depression With Mortality in Older Adults Undergoing Transcatheter or Surgical Aortic Valve Replacement

Author Affiliations
  • 1Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
  • 2Division of Vascular Surgery, McGill University, Montreal, Quebec, Canada
  • 3Faculty of Medicine, McGill University, Montreal, Quebec, Canada
  • 4Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
  • 5Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
  • 6Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
  • 7Division of Cardiac Surgery, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
  • 8Division of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
  • 9Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  • 10Division of Cardiac Surgery, Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  • 11Division of Cardiac Surgery, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
  • 12Division of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
  • 13Division of Cardiac Surgery, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
  • 14Division of Cardiology, Washington University School of Medicine, St Louis, Missouri
  • 15Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
  • 16Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
  • 17Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
  • 18Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
JAMA Cardiol. 2018;3(3):191-197. doi:10.1001/jamacardio.2017.5064
Key Points

Question  What is the prevalence of depression and its association with all-cause mortality among older adults undergoing aortic valve replacement?

Findings  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.

Meaning  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.

Abstract

Importance  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.

Objective  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.

Results  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.

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