Anemia predicts depression following ACS

8 February 2012

MedWire News: Patients with anemia admitted to hospital for acute coronary syndrome (ACS) are at increased risk for developing depression, research shows.

Anemia also predicted major adverse cardiac events (MACE) over the following 12 months.

Depression is common following ACS, with one in five patients meeting clinical criteria for a major depressive disorder, according to lead researcher Andrew Steptoe (University College, London, UK) and colleagues in the British Medical Journal.

Clinical depression and depressed mood are also predictors of future cardiac mortality and morbidity.

Interestingly, the onset of depressive symptoms following ACS appears to be unrelated to the severity of coronary disease.

Anemia, which can cause fatigue and lower quality of life, has never been examined as a predictor of depression in this setting.

The researchers evaluated the depressive symptoms of 223 patients with documented ACS using the Beck Depression Inventory (BDI) 3 weeks after hospital admission. Anemia was present in 30 (13.5%) patients.

BDI scores were significantly higher in ACS patients with anemia (mean 9.78) than those without anemia (mean 6.23) a statistically significant difference (p=0.003).

For those with anemia, 33.3% had BDI scores ≥10 whereas just 17.1% of ACS patients without anemia had elevated BDI scores.

In a multivariate adjusted model, ACS patients with anemia were more than four times more likely to have a BDI score ≥10 than those without anemia (hazard ratio=4.03, 95% confidence interval [CI] 1.48–11.0; p=0.006).

At 12 months, MACE occurred in 26.7% of patients with anemia versus 13.5% of patients without anemia. In the adjusted model, the odds for developing an adverse event were 3.26 (95% CI 1.19–8.91; p=0.021) higher for those patients with anemia.

The findings suggest that future studies need to focus on "anaemia as a possible contributor to depression following acute cardiac events and as a determinant of future cardiac morbidity," write Steptoe and colleagues.

Future studies testing the effects of anemia management on depression following ACS will help explain the anemia–depression pathway more precisely, they add.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

BMJ Open 2012; 2: e000551