The relevance of depressive symptoms for the outcome of patients receiving vitamin K antagonists: results from the thrombEVAL cohort study.

Published on Jul 23, 2021in European Heart Journal - Cardiovascular Pharmacotherapy6.617
· DOI :10.1093/EHJCVP/PVZ085
Matthias Michal27
Estimated H-index: 27
(University of Mainz),
Lisa Eggebrecht5
Estimated H-index: 5
(University of Mainz)
+ 10 AuthorsJürgen H. Prochaska14
Estimated H-index: 14
(University of Mainz)
Sources
Abstract
AIMS: Although depressive symptoms are highly prevalent in patients receiving oral anticoagulation (OAC), the relevance of depression for the outcome of anticoagulated individuals is unknown. METHODS AND RESULTS: We analyzed data from the multi-center cohort study thrombEVAL (NCT01809015), investigating the efficacy of OAC with vitamin K-antagonists. There was an independent study monitoring, and an independent review panel assessed the endpoints. Out of n = 1,558 participants, information about depressive symptoms, as measured by the two-item screener PHQ-2, was available in n = 1,405 individuals. The mean follow-up period was 28.04 months, with a standard deviation of 11.52 months. In multivariable Cox regression analysis, baseline PHQ-2 sum score was a strong and robust predictor of clinically-relevant bleeding (hazard ratio (HR) 1.13, 95% confidence interval 1.03-1.24; p = 0.011) and all-cause mortality (HR 1.18, 1.08-1.28; p = 0.001) independent of age, sex, high school graduation, partnership, clinical profile, intake of SSRI, and quality of OAC therapy. Individuals with clinically significant depressive symptoms (PHQ-2 >/=3) had a 57% increased risk for clinically relevant bleeding (fully adjusted HR 1.57, 1.08-2.28) and 54% greater risk for death (fully adjusted HR 1.54, 1.09-2.17). There was no association of depressive symptoms with thromboembolic events. For hospitalization, individuals with depressive symptoms (PHQ-2 >/=3) did not experience an elevated risk in the fully adjusted model (HR 1.08, 0.86, 1.35; p = 0.52). CONCLUSIONS: Assessment of depression by the PHQ-2 provided independent long-term prognostic information beyond common biomedical risk factors. These findings highlight the need for targeting depressive symptoms in the management of patients receiving OAC therapy.
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#2Katherine Huber (UF: University of Florida)H-Index: 3
Last. Eric Dietrich (UF: University of Florida)H-Index: 10
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Abstract Background Direct oral anticoagulants (DOACs) are high risk medications with short half-lives making adherence vitally important. Global measures for adherence have been described; however, there is a lack of patient-level data on adherence. Methods This prospective, single-center study in an interdisciplinary internal medicine clinic included patients referred by their primary care physician for DOAC therapy evaluation. Patients were interviewed by a clinical pharmacist who confirmed d...
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Background Psychosocial factors in cardiovascular diseases are increasingly acknowledged by patients, health care providers and payer organizations. Due to the rapidly increasing body of evidence, the German Cardiac Society has commissioned an update of its 2013 position paper on this topic. The German version was published in 2018 and the current manuscript is an extended translation of the original version.
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Abstract Objective An American Heart Association (AHA) Science Advisory recommends patients with coronary heart disease undergo routine screening for depressive symptoms with the two-stage Patient Health Questionnaire (PHQ). However, little is known on the prognostic impact of a positive PHQ screen on heart failure (HF) mortality. Methods We screened hospitalized patients with systolic HF (left ventricle ejection fraction≤40%) for depression with the two-item Patient Health Questionnaire (PHQ-2)...
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#2Jürgen H. Prochaska (University of Mainz)H-Index: 14
Last. Philipp S. Wild (University of Mainz)H-Index: 66
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Abstract Background/objectives Depression and anxiety are highly prevalent in cardiovascular patients. Therefore, we examined whether the 4-item Patient Health Questionnaire (PHQ-4, measuring symptoms of depression and anxiety) predicts all-cause mortality in outpatients with long-term oral anticoagulation (OAC). Methods The sample comprised n=1384 outpatients from a regular medical care setting receiving long-term OAC with vitamin K antagonists. At baseline, symptoms of anxiety and depression w...
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