High Rates of Depression, Mortality in Older Adults Undergoing TAVR or SAVR

Depression is a risk factor for adverse outcomes in older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement. A recent Canadian study published in JAMA Cardiology found that one-third of these patients showed depressive symptoms at baseline and a higher risk for short- and mid-term mortality. Moreover, patients with persistent depressive symptoms at follow-up had the highest risk for mortality.

The researchers analyzed data from the multicenter multinational Frailty Aortic Valve Replacement (FRAILTY-AVR) study from November 15, 2011 through April 7, 2016. Individuals who underwent TAVR or SAVR (age ≥70) were enrolled in the study. 

Depressive symptoms were evaluated using the Geriatric Depression Scale (GDS) Short Form at baseline and follow-up.

The main outcome was all-cause mortality at 1 and 12 months following TAVR or SAVR. The researchers used logistic regression to determine the association between depression and mortality after adjusting for confounders (eg, frailty and cognitive impairment).

Of the 1035 study participants — 427 men (41.3%) and 608 women (58.7%); mean age standard deviation (SD) 81.4 (6.1) years — 326 (31.5%) had a positive result with screening for depression, although only 89 (8.6%) had depression documented in their clinical record.

Baseline depression was found to be associated with mortality at 1 month (odds ratio [OR] 2.20; 95% CI, 1.18-4.10) and at 12 months (OR 1.532; 95% CI, 1.03-2.24), after adjusting for clinical and geriatric confounders.

Persistent depression (ie, baseline depression that was still present 6 months after the procedure) was associated with a 3-fold increase in mortality at 12 months (OR 2.98; 95% CI, 1.08-8.20).

The researchers noted that their study was the first “to investigate the interplay among depression, frailty, and mortality in older adults undergoing TAVR and SAVR,” and that their findings suggest that “depression is underdiagnosed and affects as many as 1 in 3 patients in this context.”

The findings have important clinical implications. “Screening for depression may be justified during the baseline evaluation and follow-up of patients with severe aortic stenosis who are referred for aortic valve replacement,” they concluded.

Reference

Drudi LM, Ades M, Turkdogan S, et al. Association of depression with mortality in older adults undergoing transcatheter or surgical aortic valve replacement [published online January 17,2018]. JAMA Cardiol. doi:10.1001/jamacardio.2017.5064