Depressive symptoms are common following acute coronary syndrome (ACS) and predict subsequent cardiovascular morbidity. Depression in acute cardiac patients appears to be independent of clinical disease severity and other cardiovascular measures. One factor that has not been considered previously is anaemia, which is associated with fatigue and adverse cardiac outcomes. This study assessed the relationship between anaemia on admission and depressive symptoms following ACS.
Longitudinal clinical observational study.
Coronary care unit.
223 patients with documented ACS.
Main outcome measures
Depressive symptoms measured with the Beck Depression Inventory 3 weeks after admission.
Anaemia was defined with WHO criteria and was present in 30 (13.5%) patients. Anaemia predicted raised depression scores 3 weeks later independently of age, gender, marital status, educational attainment, smoking, Global Registry of Acute Cardiac Events (GRACE) risk scores, negative mood in hospital and history of depression (p=0.003). The odds of a Beck Depression Inventory score ≥10 among anaemic patients were 4.03 (95% CIs 1.48 to 11.00), adjusted for covariates. Sensitivity analyses indicated that effects were also present when haemoglobin was analysed as a continuous measure. Anaemia also predicted major adverse cardiac events over the subsequent 12 months.
Anaemia appears to contribute to depression following ACS and is associated with future cardiac morbidity. Studies evaluating the effects of anaemia management will help delineate the role of this pathway more precisely.
Depressive symptoms are common among survivors of acute myocardial infarction and other acute coronary syndromes (ACS) and predict a poor long-term outcome.
Depressive symptoms appear to be independent of clinical disease severity.
However, anaemia is common in ACS patients and has not previously been examined as a predictor of depressive symptoms.
Anaemia on admission with ACS predicted depressive symptoms 3 weeks later, independently of covariates.
Anaemia also predicted major adverse cardiac events over the next 12 months.
Anaemia and haemoglobin levels should be considered as biological determinants of depressive symptoms following myocardial infarction and other ACSs.
Strengths and limitations of this study
This is the first study to investigate anaemia and subsequent depression in ACS patients using a prospective design.
The study was small scale and was not powered to investigate the impact of depression on long-term cardiac outcomes.