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Review: depression after myocardial infarction is associated with increased risk of all-cause mortality and cardiovascular events

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Question: Is depression after myocardial infarction (MI) associated with risk of all-cause mortality and further cardiovascular events after adjusting for severity of cardiac disease and other health-related variables?

Outcomes: All-cause mortality and both fatal and non-fatal cardiovascular events.


Design: Systematic review and individual patient meta-analysis.

Data sources: MEDLINE (PubMed), EMBASE and PyscINFO were searched between 1975 and 5 January 2011, with search alerts set-up to identify studies published after this date. In addition, relevant reviews and articles were cross-referenced.

Study selection and analysis: Prospective studies that investigated the association between postinfarction depression and all-cause mortality and/or cardiovascular events. Depression had to be assessed using validated methods (self-report questionnaire or standardised diagnostic interview) within 3 months of hospital admission for myocardial infarction (MI). Study authors were contacted to obtain original data on patient demographics, depression, disease severity, comorbidities, medication use and outcomes. Depression scores from individual studies were standardised to z-scores. Studies reporting time-to-event data were combined to calculate HZ using multilevel Cox proportional hazard regression analysis. All studies, including those …

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  • Competing interests JCH has received grants to study depression in cardiac patients in the past (American Heart Association; Scientist Development Grant 0735530T and American Heart Association; Grant-in-Aid 10GRNT3450015).