Relationship of depression screening in cardiometabolic disease with vascular events and mortality: findings from a large primary care cohort with 4 years follow-up

Jani, B. D. , Boachie, C., McCowan, C. , Barry, S. J.E. , Cavanagh, J. and Mair, F. S. (2017) Relationship of depression screening in cardiometabolic disease with vascular events and mortality: findings from a large primary care cohort with 4 years follow-up. European Heart Journal: Quality of Care and Clinical Outcomes, 3(1), pp. 61-73. (doi:10.1093/ehjqcco/qcw045) (PMID:28927181)

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Abstract

Aims: Benefits of routine depression screening for cardiometabolic disease patients remain unclear. We examined the association between depression screening and all-cause mortality and vascular events in cardiometabolic disease patients. Methods and results: 125 143 patients with cardiometabolic diseases (coronary heart disease, diabetes or previous stroke) in the UK participated in primary care chronic disease management in 2008/09, which included depression screening using the Hospital Anxiety and Depression Score. 10 670 receiving depression treatment exempted, 35 537 screened, while 78 936 not screened. We studied all-cause mortality and vascular events at 4 years, by electronic data linkage of 124 414 patients (99.4%) on primary care registers to hospital discharge and mortality records and used Cox proportional hazards on matched data using propensity score. Mean age for the screened and not screened population was 69 years (standard deviation—SD 11.9) and 67 years (SD 14.3), respectively; 58% (20 658) of the screened population were men and 65.3% (22 726) were socioeconomically deprived, compared with 54.2% (42 727) and 67.4% (51 686), respectively, in the not screened population. The screened population had lower all-cause mortality (Hazard Ratio—HR 0.89) and vascular events (HR 0.85) in the matched data of N = 21 893 patients each in the screened and the unscreened groups. Conclusion: Depression screening was associated with a reduction in all-cause mortality and vascular events in patients with cardiometabolic diseases. The uptake of screening was poor for unknown reasons. Reverse causality and confounding by disease severity and quality of care are important possible limitations. Further research to determine reproducibility and explore underlying mechanisms is merited.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cavanagh, Professor Jonathan and Boachie, Mr Charles and Jani, Dr Bhautesh and Mccowan, Professor Colin and Barry, Dr Sarah and Mair, Professor Frances
Authors: Jani, B. D., Boachie, C., McCowan, C., Barry, S. J.E., Cavanagh, J., and Mair, F. S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Heart Journal: Quality of Care and Clinical Outcomes
Publisher:Oxford University Press
ISSN:2058-5225
ISSN (Online):2058-1742
Published Online:06 October 2016
Copyright Holders:Copyright © 2016 Oxford University Press
First Published:First published in European Heart Journal: Quality of Care and Clinical Outcomes 3(1): 61-73
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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