Speaking in a forum of front-line service providers and the community members
Good evening everybody,
Depression has been shown to be a risk factor for mortality during the 12 months following acute myocardial infestion and stroke.Research of good quality namely the metaanylyses of various studies confirms that acute myocardial infarction(heart attack) and strokeare often accompahied by depression and anxiety. This may be either during the attack and hence being a contributory factor to it, or following later during the recovery phase.
About 40% of the patients within 6 months of heart attack or stroke have depression and a lot ( stats not available) more have anxiety or anxious personality. In fact we know that most of the people who suffer from the two ailments have the Type A personality , which is itself associated with anxiety.
The depression may be clinical i.e. with obvious signs and symptoms, or sub-clinical i.e. the symptoms are not obvious and hence often get missed by the treating cardiologist or neurologist unless they maintain a high index of suspicion.
Depression among these two group of patients is associated with broad range of adverse outcomes including mortality , prolonged hospitalisation, worse health status and a repeat event of heart attack or stroke.
One interesting study showed that the younger women (<60 yrs) are the most vulnerable group to be depressed and they are more likely to be–dark skinned, with low household income, single status, less than University education and a smoker. They are also more likely to be having other co morbid conditions like Diabetes, obesity, raised Cholesterol, CCF. But they are unlikely to be on b-blockers.
Amongst the men they are likely to be Hypertensive, have had revascularization procedure and lower ejection fraction i.e. lower pumping ability of the heart.
23% of the patients discharged from the hospital post MI or Stroke treatment have clinical depression.
Out of those depressed only 27% ( 31% of women and 24% of men) had previous history of depression prior to the event. This implies that about 73% had the depression, triggerd by the event.
Unfortunately only 18% are discharged with a prescription medication for depression or referred for psychotherapy.
So it is important to clinically recognise depression in patients associated with MI or Stroke. Not only is depression an important illness in its own right, it confers 3-5 times higher risk of mortality within 6 months of the event. The mortality is high even in the absence of clinical diagnosis of major depression-with clear dose response relationship i.e.the more severe the depression, the more are the chances of dying in the next 6 months, and then also more chances of longer hospitalisation, worse symptomatology, psychological and social outcome in the next 3 and 12 months.
And patients with moderate to severe depressive symptoms require treatment and close followup with monitoring of their mood and compliance to the treatment
Aggressive screening of the patient for depression and anxiety at the time of admission, during hospital stay, at discharge and then followup with the Cardiologist or the Neurologist or the Family Physician.
About 25 % patients on treatment for depression after MI or Stroke do not respond to the medication and the depressive symptoms persist. Such patients need more stepped up care, even closer monitoring along with polytherapy and even Electroconvulsive therapy.
It is important for the post MI or Stroke patient to join a Cardiac or Stroke Rehabilitation Program. The programs with the help of the Rehab Team tailor the services to the patient.
You all can help find a rehab program for your clients in your community through Family Physicians, hospital where patient was treated, Public Health Department otr the local office of the Heart and Stroke Foundation.
Information about Cardiac/ Stroke Rehab is available at the HSFO website.
Take home message friends:
1. There is high ( 40%) incident of depression in post MI/Stroke patients
2 .Keep high index of suspicion to identify the depressed patients.
3. Its a viscious cirlce with MI/Stoke and Depression exacerbating each other.
4. Most vulnerable group ios the women below 60 yrs of age.
5. Timely diagnosis, treatment and foillowup can improve the physical as wel as the mental outcome of the patient post MI/Stroke.
Lead, South Asian Health Ambassador
Heart and Stroke Foundation of Ontario | Finding answers. For life.
Tel: 905.451.0021 905.451.0021 | Cell: 416-629-1689 416-629-1689 e Fax: 905.452.0503 | Address: 201 County Court Blvd., Suite 306 , Brampton , Ontario , L6W 4