Stroke survivors at increased risk for depression vs. those with myocardial infarction

Stroke survivors experienced a substantially increased risk for subsequent depression compared with those who had a myocardial infarction, according to results of a retrospective cohort study published in Neurology.

Mandip Dhamoon

“Post-stroke depression affects approximately one-third of patients and is known to be associated with poorer outcomes, yet epidemiology and pathogenesis are poorly understood,” Mandip Dhamoon, MD, DrPH, associate professor in the department of neurology at Mount Sinai’s Icahn School of Medicine, told Healio Neurology. “By comparing post-stroke depression to post-myocardial infarction depression, we sought to gain insight into the mental health implications of two different ischemic vascular events. One must consider the possibility that there is a unique biological component to post-stroke depression related to ischemic damage to the brain.”

Dhamoon and colleagues analyzed 100% de-identified inpatient, outpatient and subacute nursing Medicare data from individuals. They included data from 174,901 patients who experienced a stroke and 193,418 patients with myocardial infarction aged 65 years or older between July 1, 2016, and Dec. 31, 2017. They estimated Kaplan-Meier unadjusted cumulative depression risk for a maximum of 1.5 years after index admission. They also conducted Cox regression to determine the hazard ratio for depression diagnosis a maximum of 1.5 years after stroke compared with myocardial infarction, as well as to identify independent predictors of post-stroke depression. They adjusted for patient demographics, length of stay, comorbidities and interventions for acute stroke.

Results of fully adjusted models demonstrated an approximately 50% increased risk among patients who experienced a stroke for the development of depression compared with patients with myocardial infarction across 1.5 years of follow up, according to a Kaplan-Meier cumulative risk analysis (P for log-rank < .0001). History of anxiety served as the most significant predictor of post-stroke depression, whereas discharge home had the greatest protective effect. Women, white individuals and those aged younger than 75 years all had increased risk for post-stroke depression diagnosis.

According to Dhamoon, it is possible for the characteristics associated with depression after stroke to be incorporated into electronic health records to alert physicians of an individual patient’s risk.

“Every member of the patient’s treatment team has an obligation to screen for and treat post-stroke depression, as indicated, at every interaction with the health care system,” Dhamoon said. “EHRs are increasingly being used to improve the quality and efficiency of our care, and we fully support its use as aid to diagnosing something as important and treatable as post-stroke depression.”

He also emphasized the role of timely intervention in treating post-stroke depression.

“Our findings highlight the need for consistent depression screening and treatment in all stroke patients regardless of how long ago the stroke was,” Dhamoon said. “Post-stroke depression is a treatable illness and, especially when untreated, leaves our patients at greater risk for poorer quality of life and outcomes following stroke.”