Background: Depression is considered an independent risk factor for coronary artery disease. Post-myocardial infarction (PMI) depression, is an increasingly recognized clinical entity with a prevalence of 10%. Compared with other ethnic groups, African Americans (AA) are more likely to be depressed and have higher coronary artery disease (CAD) burden. Few studies have evaluated the implications of PMI depression in African Americans.
Methods: We obtained data from electronic medical records of a large safety-net hospital in Atlanta, Georgia. We included AA with discharge diagnoses of acute coronary syndrome who had depression screening between July 2018 and December 2018. PMI depression was defined by PHQ-9 score > 5 within 8 weeks of discharge. We determined the association between gender, age, insurance status and presence of comorbidities and depression. Multivariable-adjusted logistic regression models were used to estimate the association between PMI depression and the occurrence of readmissions for cardiovascular causes over a 12-month post-discharge period. Results were reported as adjusted odds ratios (95% confidence intervals)
Results: PMI depression was present in 27% (n=25/91) of the patients screened. The mean age was 58.7 ± 11 (61.5% male, 38.5% female). Of the total number of patients with PMI depression, 40% had mild depression, 48% had moderate depression and 12 % had severe depression. Women were more likely to be depressed than men aOR 2.87; CI (1.09 – 7.52). Readmission rates were higher among those with positive depression screen, compared with those without PMI depression 44% (n=11/25) vs 31% (n=21/66). After adjusting for selected covariates, the aOR for all causes cardiovascular readmission was higher in the depressed patients aOR 2.71; CI (0.91 – 8.08) p= 0.07
Conclusions: Post-myocardial infarction depression may be associated with all increased frequency of cardiovascular readmissions in African Americans. Future studies will look to identify clinical, sociodemographic and system-level contributors to PMI depression and strategies to mitigate its attendant risks.