Depression increases risk of death in patients with chronic stable angina

04/10/2016

Depression affects one in five patients with a new diagnosis of chronic stable angina and is associated with poor outcomes, including heart attack and death, according to a new study from the Institute for Clinical Evaluative Sciences (ICES).

The researchers identified all Ontario residents over the age of 20 years who had been diagnosed with stable angina from October 2008 to September 2013 based on obstructive coronary artery disease found on an angiogram (a procedure that uses X-ray imaging to see the heart's blood vessels). Of the 22, 917 people identified, 18.8 per cent (about 1 in 5) experienced a first occurrence of depression within the first three years after their angiogram.

“We found that patients with chronic stable angina who experienced a depressive episode had a worse prognosis, with a significantly higher likelihood of all-cause mortality and admission for heart attack,” says Dr. Harindra Wijeysundera, lead author of the study and ICES scientist.

The study was published today in Circulation: Cardiovascular Quality and Outcomes.

Chronic stable angina is a form of chest pain that happens when the heart is working hard and needs more oxygen, such as during exercise. Depression is common in patients after a heart attack and is associated with poor outcomes, but its relationship with stable angina is less well established.

The researchers also found:

Occurrence of depression after a new diagnosis of stable angina affects nearly 1 in 5 individuals.
The strongest predictors of depression post-angiography are a remote history of depression, as well as being a woman.
Depression is associated with poor outcomes, with 7.6 per cent of patients with depression dying compared to 6.4 per cent of those patients without.
Patients with depression also had a higher risk of another heart attack (4.7 per cent compared to 2.8 per cent).

“Clinical impact of subsequent depression in patients with a new diagnosis of stable angina: a population-based study” was published today in Circulation: Cardiovascular Quality and Outcomes.

Author block: Szpakowski N, Bennell MC, Qiu F, Ko DT, Tu JV, Kurdyak P, Wijeysundera H.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario