1Bremer Institut für Herz- und Kreislaufforschung (BIHKF) Bremen, Deutschland; 2Klinikum Lippe-Detmold Universitätsklinik für Kardiologie, Angiologie, Intensivmedizin Detmold, Deutschland; 3Herzzentrum Dresden GmbH an der TU Dresden Klinik für Innere Medizin, Kardiologie und Intensivmedizin Dresden, Deutschland; 4Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland
Introduction: Major depression (MD) is a risk factor for adverse cardiovascular events and management of patients with MD is considered to be challenging. It was the aim of the present study to analyze the characteristics of patients with acute myocardial infarction (MI) and MD and to investigate if an intensive prevention program (IPP) with prevention assistants improves long-term risk factor control and depression in this special group.
Methods: In the present substudy of the multicenter, randomized IPP (Intensive Prevention Program) and NET-IPP (New Technologies in Intensive Prevention Programs) trials, patients with MI and MD vs. no MD were investigated. Using the standardized Patient Health Questionnaire-9 (PHQ-9), MD was diagnosed if patients scored ≥ 10 points. The effects of 12 months IPP, including repetitive contacts between patients and trained non-physician prevention assistants that were supervised by physicians, were evaluated.
Results: Out of 523 patients with MI, MD was diagnosed in 80 patients (15.3%). Patients with MD were younger (53.8 ± 8.3 vs. 57.1 ± 9.5 years, p < 0.05) and more often female (32.5% vs. 18.3%, p < 0.05) than patients without MD.
At time of index MI an elevated rate of active smoking (52.5% vs. 41.3%, p < 0.05) and BMI > 25 kg/m2 (85.0% vs. 73.6%, p < 0.05) was observed in patients with MD; the rate of physical inactivity was high in both groups (63% vs. 62%, p = n.s.).
Over 12 months IPP was effective to reduce the risk factors smoking (-81% reduction, p<0.05 compared to usual care) and physical inactivity (-64% reduction, p<0.05 compared to usual care) in patients with MD (Figure 1). In addition, IPP reduced the rate of obesity in the group with MD; however, the difference compared to usual care was not statistically significant (IPP: -25% obese patients; usual care: +18% obese patients) and might have been attenuated by smoking cessation (leading to weight gain).
Out of the patients with initial diagnosis of MD, MD (PHQ-9 ≥ 10 points) was still diagnosed at 12 months in 13.2% of the IPP group compared to 39.5% of the usual care group (p<0.05).
Conclusions: Patients with MI and MD are characterized by additional risk factors, such as smoking and elevated BMI. Even in this challenging high-risk cohort, 12-months IPP with trained prevention assistants was effective to improve long-term risk factor control. The rate of persistent MD at 12 months was reduced significantly by IPP.
Figure 1: Effects of a 12-months Intensive Prevention Program (IPP) vs. Usual Care in patients with myocardial infarction and major depression vs. no major depression.
A Smoking cessation, B Change in physical inactivity.