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

Bhautesh Dinesh Jani, Charles Boachie, Colin McCowan, Sarah J.E. Barry, Jonathan Cavanagh, Frances S. Mair

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.
LanguageEnglish
Pages61-73
Number of pages13
JournalEuropean Heart Journal - Quality of Care & Clinical Outcomes
Volume3
Issue number1
DOIs
Publication statusPublished - 1 Jan 2017

Fingerprint

Vascular Diseases
Primary Health Care
Depression
Blood Vessels
Mortality
Population
Propensity Score
Quality of Health Care
Information Storage and Retrieval
Disease Management
Hospital Mortality
Causality
Coronary Disease
Chronic Disease
Anxiety
Stroke
Research

Keywords

  • depression
  • coronary heart disease
  • diabetes mellitus
  • stroke
  • cardiovascular complications

Cite this

@article{c168f716313d4d2da0be0cb8935c6b5c,
title = "Relationship of depression screening in cardiometabolic disease with vascular events and mortality: findings from a large primary care cohort with 4 years follow-up",
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.",
keywords = "depression, coronary heart disease, diabetes mellitus, stroke, cardiovascular complications",
author = "Jani, {Bhautesh Dinesh} and Charles Boachie and Colin McCowan and Barry, {Sarah J.E.} and Jonathan Cavanagh and Mair, {Frances S.}",
year = "2017",
month = "1",
day = "1",
doi = "10.1093/ehjqcco/qcw045",
language = "English",
volume = "3",
pages = "61--73",
journal = "European Heart Journal - Quality of Care & Clinical Outcomes",
issn = "2058-5225",
number = "1",

}

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, Bhautesh Dinesh; Boachie, Charles; McCowan, Colin; Barry, Sarah J.E.; Cavanagh, Jonathan; Mair, Frances S.

In: European Heart Journal - Quality of Care & Clinical Outcomes , Vol. 3, No. 1, 01.01.2017, p. 61-73.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Relationship of depression screening in cardiometabolic disease with vascular events and mortality: findings from a large primary care cohort with 4 years follow-up

AU - Jani, Bhautesh Dinesh

AU - Boachie, Charles

AU - McCowan, Colin

AU - Barry, Sarah J.E.

AU - Cavanagh, Jonathan

AU - Mair, Frances S.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

KW - depression

KW - coronary heart disease

KW - diabetes mellitus

KW - stroke

KW - cardiovascular complications

U2 - 10.1093/ehjqcco/qcw045

DO - 10.1093/ehjqcco/qcw045

M3 - Article

VL - 3

SP - 61

EP - 73

JO - European Heart Journal - Quality of Care & Clinical Outcomes

T2 - European Heart Journal - Quality of Care & Clinical Outcomes

JF - European Heart Journal - Quality of Care & Clinical Outcomes

SN - 2058-5225

IS - 1

ER -