Sian Claire Owen, medical journalist for Cardio Debate, UK

Depression in the elderly is prevalent in patients undergoing transcatheter or surgical aortic valve replacement. A recent multi-centre prospective cohort study explored the relationship between the symptoms of depression and these procedures and found that patients with evidence of depression at baseline were at a subsequently higher risk of mortality.

In this study, FRAILTY-AVR, researchers looked at depression symptoms in 1035 older adults aged >70 years undergoing transcatheter or surgical aortic valve replacement. Of these, 31.5% had evidence of depression at baseline and a higher risk of short- and mid-term mortality. Furthermore, the risk of mortality increased in patients where depressive symptoms persisted after the procedure. [1] In fact the highest risk cohort had a three-fold increased risk of mortality at 12 months afterwards. The study authors suggest that screening for depression prior to these procedures may help reduce mortality in this patient population.

However, not everyone is convinced that this is an effective solution. Doctors Amisha Patel and Martin B Leon, both from Columbia University Medical Center, New York, NY, argue in an editorial published in JAMA Cardiol (also quoted in Medscape) that “as the dominant symptom [in these patients] is usually heart failure, it is usually difficult to isolate depression caused by valvular disease from these other comorbidities.” [2, 3]

Other experts argue that screening for symptoms of depression in this patient population would only be useful if there was accompanying treatment, including therapy and medication. [3]

The link between depression and various types of CVD are well-established. A report published in 2017 in Therapeutics and Clinical Risk Management looked at the impact of depression on coronary heart disease risk, using the Framingham CHD Risk Score. Here, it was found that depression in women significantly increased the CHD risk score from a low-risk to an intermediate- or high-risk group, compared to those without depressive symptoms. [4]

According to the British Heart Foundation, depression is two to three times more prevalent in people with heart or circulatory disease [5] Their 2012 report ‘Twice as likely: Putting long-term conditions and depression on the agenda’ states that “long term conditions coupled with depression are a significant and growing challenge,” that costs the NHS up to £13 billion. [6]

The aging population means that this problem is not going away any time soon. Conversations regarding the benefits of screening for depression to reduce mortality in certain patient populations are a step in the right direction.

References

  1. https://jamanetwork.com/journals/jamacardiology/article-abstract/2669918?
  2. https://jamanetwork.com/journals/jamacardiology/article-abstract/2669917?redirect=true
  3. https://www.medscape.com/viewarticle/891624
  4. https://www.bhf.org.uk/about-us/our-policies/treatment-and-care-policies/heart-disease-and-depression
  5. https://www.bhf.org.uk/publications/policy-documents/twice-as-likely-putting-long-term-conditions-and-depression-on-the-agenda—april-2012