Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study

Robert M. Carney, James A. Blumenthal, Kenneth E. Freedland, Marston Youngblood, Richard C. Veith, Matthew M. Burg, Carol Cornell, Patrice G. Saab, Peter G. Kaufmann, Susan M. Czajkowski, Allan S Jaffe

Research output: Contribution to journalArticle

204 Citations (Scopus)

Abstract

Objective: The Enhancing Recovery in Coronary Heart Disease study was a multicenter clinical trial in which patients with depression and/or low perceived social support after an acute myocardial infarction were randomly assigned to an intervention consisting of cognitive behavior therapy and, in some cases, sertraline, or to usual care. There was no difference in survival between the groups. A possible reason why the intervention failed to affect survival is that too many patients with mild, transient depression were enrolled. Another is that some patients died too soon to complete the intervention. This analysis evaluates whether there was a difference in late (ie, ≥6 months after the myocardial infarction) mortality among initially depressed patients who had a Beck Depression Inventory score ≥10 and a past history of major depression, and who completed the 6-month post-treatment assessment. It also examines the relationship between change in depression and late mortality. Methods: Out of the 1,165 (47%) of the Enhancing Recovery in Coronary Heart Disease study participants who met our criteria, 57 died in the first 6 months, and 858 (409 usual care, 449 intervention) completed the 6-month assessment. Cox regression was used to analyze survival. Results: The intervention did not affect late mortality. However, intervention patients whose depression did not improve were at higher risk for late mortality than were patients who responded to treatment. Conclusions: Patients whose depression is refractory to cognitive behavior therapy and sertraline, two standard treatments for depression, are at high risk for late mortality after myocardial infarction.

Original languageEnglish (US)
Pages (from-to)466-474
Number of pages9
JournalPsychosomatic Medicine
Volume66
Issue number4
DOIs
StatePublished - Jul 2004

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Coronary Disease
Myocardial Infarction
Depression
Mortality
Sertraline
Cognitive Therapy
Treatment-Resistant Depressive Disorder
Survival
Survival Analysis
Social Support
Multicenter Studies
Therapeutics
Clinical Trials
Equipment and Supplies

Keywords

  • Cognitive therapy
  • Depression
  • Depressive disorder
  • Mortality
  • Myocardial infarction

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Psychology(all)

Cite this

Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study. / Carney, Robert M.; Blumenthal, James A.; Freedland, Kenneth E.; Youngblood, Marston; Veith, Richard C.; Burg, Matthew M.; Cornell, Carol; Saab, Patrice G.; Kaufmann, Peter G.; Czajkowski, Susan M.; Jaffe, Allan S.

In: Psychosomatic Medicine, Vol. 66, No. 4, 07.2004, p. 466-474.

Research output: Contribution to journalArticle

Carney, RM, Blumenthal, JA, Freedland, KE, Youngblood, M, Veith, RC, Burg, MM, Cornell, C, Saab, PG, Kaufmann, PG, Czajkowski, SM & Jaffe, AS 2004, 'Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study', Psychosomatic Medicine, vol. 66, no. 4, pp. 466-474. https://doi.org/10.1097/01.psy.0000133362.75075.a6
Carney, Robert M. ; Blumenthal, James A. ; Freedland, Kenneth E. ; Youngblood, Marston ; Veith, Richard C. ; Burg, Matthew M. ; Cornell, Carol ; Saab, Patrice G. ; Kaufmann, Peter G. ; Czajkowski, Susan M. ; Jaffe, Allan S. / Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study. In: Psychosomatic Medicine. 2004 ; Vol. 66, No. 4. pp. 466-474.
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AB - Objective: The Enhancing Recovery in Coronary Heart Disease study was a multicenter clinical trial in which patients with depression and/or low perceived social support after an acute myocardial infarction were randomly assigned to an intervention consisting of cognitive behavior therapy and, in some cases, sertraline, or to usual care. There was no difference in survival between the groups. A possible reason why the intervention failed to affect survival is that too many patients with mild, transient depression were enrolled. Another is that some patients died too soon to complete the intervention. This analysis evaluates whether there was a difference in late (ie, ≥6 months after the myocardial infarction) mortality among initially depressed patients who had a Beck Depression Inventory score ≥10 and a past history of major depression, and who completed the 6-month post-treatment assessment. It also examines the relationship between change in depression and late mortality. Methods: Out of the 1,165 (47%) of the Enhancing Recovery in Coronary Heart Disease study participants who met our criteria, 57 died in the first 6 months, and 858 (409 usual care, 449 intervention) completed the 6-month assessment. Cox regression was used to analyze survival. Results: The intervention did not affect late mortality. However, intervention patients whose depression did not improve were at higher risk for late mortality than were patients who responded to treatment. Conclusions: Patients whose depression is refractory to cognitive behavior therapy and sertraline, two standard treatments for depression, are at high risk for late mortality after myocardial infarction.

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