Low heart rate variability and the effect of depression on post-myocardial infarction mortality

Robert M. Carney, James A. Blumenthal, Kenneth E. Freedland, Phyllis K. Stein, William B. Howells, Lisa F. Berkman, Lana L. Watkins, Susan M. Czajkowski, Junichiro Hayano, Peter P. Domitrovich, Allan S Jaffe

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Abstract

Background: Depression is associated with an increased risk for mortality after acute myocardial infarction (MI). The purpose of this study was to determine whether low heart rate variability (HRV) mediates the effect of depression on mortality. Methods: Twenty-four-hour ambulatory electrocardiograms were obtained from 311 depressed patients with a recent acute MI who were enrolled in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial and from 367 nondepressed patients who met the ENRICHD medical inclusion criteria. Standard HRV indexes were extracted from the recordings. Results: The log of very low-frequency (LnVLF) power, an index of HRV derived from power spectral analysis of the electrocardiogram signal (0.0033-0.04 Hz [in milliseconds squared]), was lower in the depressed than in the nondepressed patients (P<.001). There were 47 deaths (6.1%) during a 30-month follow-up. After adjusting for potential confounders, the depressed patients remained at higher risk for all-cause mortality compared with the nondepressed patients (hazard ratio, 2.8; 95% confidence interval [CI], 1.4-5.4; P<.003). When LnVLF power was entered into the model, the hazard ratio for depression dropped to 2.1 (95% CI, 1.1-4.2; P=.03). The proportion of the risk for depression attributable to LnVLF power was 0.27 (95% CI, 0.23-0.31; P<.001). Conclusions: Low HRV partially mediates the effect of depression on survival after acute MI. This finding helps to clarify the physiological mechanisms underlying depression's role as a risk factor for mortality in patients with coronary heart disease. It also raises the possibility that treatments that improve both depression and HRV might also improve survival in these patients.

Original languageEnglish (US)
Pages (from-to)1486-1491
Number of pages6
JournalArchives of Internal Medicine
Volume165
Issue number13
DOIs
StatePublished - Jul 11 2005

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Heart Rate
Myocardial Infarction
Mortality
Coronary Disease
Confidence Intervals
Electrocardiography
Survival
Proportional Hazards Models
Clinical Trials

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Carney, R. M., Blumenthal, J. A., Freedland, K. E., Stein, P. K., Howells, W. B., Berkman, L. F., ... Jaffe, A. S. (2005). Low heart rate variability and the effect of depression on post-myocardial infarction mortality. Archives of Internal Medicine, 165(13), 1486-1491. https://doi.org/10.1001/archinte.165.13.1486

Low heart rate variability and the effect of depression on post-myocardial infarction mortality. / Carney, Robert M.; Blumenthal, James A.; Freedland, Kenneth E.; Stein, Phyllis K.; Howells, William B.; Berkman, Lisa F.; Watkins, Lana L.; Czajkowski, Susan M.; Hayano, Junichiro; Domitrovich, Peter P.; Jaffe, Allan S.

In: Archives of Internal Medicine, Vol. 165, No. 13, 11.07.2005, p. 1486-1491.

Research output: Contribution to journalArticle

Carney, RM, Blumenthal, JA, Freedland, KE, Stein, PK, Howells, WB, Berkman, LF, Watkins, LL, Czajkowski, SM, Hayano, J, Domitrovich, PP & Jaffe, AS 2005, 'Low heart rate variability and the effect of depression on post-myocardial infarction mortality', Archives of Internal Medicine, vol. 165, no. 13, pp. 1486-1491. https://doi.org/10.1001/archinte.165.13.1486
Carney RM, Blumenthal JA, Freedland KE, Stein PK, Howells WB, Berkman LF et al. Low heart rate variability and the effect of depression on post-myocardial infarction mortality. Archives of Internal Medicine. 2005 Jul 11;165(13):1486-1491. https://doi.org/10.1001/archinte.165.13.1486
Carney, Robert M. ; Blumenthal, James A. ; Freedland, Kenneth E. ; Stein, Phyllis K. ; Howells, William B. ; Berkman, Lisa F. ; Watkins, Lana L. ; Czajkowski, Susan M. ; Hayano, Junichiro ; Domitrovich, Peter P. ; Jaffe, Allan S. / Low heart rate variability and the effect of depression on post-myocardial infarction mortality. In: Archives of Internal Medicine. 2005 ; Vol. 165, No. 13. pp. 1486-1491.
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abstract = "Background: Depression is associated with an increased risk for mortality after acute myocardial infarction (MI). The purpose of this study was to determine whether low heart rate variability (HRV) mediates the effect of depression on mortality. Methods: Twenty-four-hour ambulatory electrocardiograms were obtained from 311 depressed patients with a recent acute MI who were enrolled in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial and from 367 nondepressed patients who met the ENRICHD medical inclusion criteria. Standard HRV indexes were extracted from the recordings. Results: The log of very low-frequency (LnVLF) power, an index of HRV derived from power spectral analysis of the electrocardiogram signal (0.0033-0.04 Hz [in milliseconds squared]), was lower in the depressed than in the nondepressed patients (P<.001). There were 47 deaths (6.1{\%}) during a 30-month follow-up. After adjusting for potential confounders, the depressed patients remained at higher risk for all-cause mortality compared with the nondepressed patients (hazard ratio, 2.8; 95{\%} confidence interval [CI], 1.4-5.4; P<.003). When LnVLF power was entered into the model, the hazard ratio for depression dropped to 2.1 (95{\%} CI, 1.1-4.2; P=.03). The proportion of the risk for depression attributable to LnVLF power was 0.27 (95{\%} CI, 0.23-0.31; P<.001). Conclusions: Low HRV partially mediates the effect of depression on survival after acute MI. This finding helps to clarify the physiological mechanisms underlying depression's role as a risk factor for mortality in patients with coronary heart disease. It also raises the possibility that treatments that improve both depression and HRV might also improve survival in these patients.",
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AU - Howells, William B.

AU - Berkman, Lisa F.

AU - Watkins, Lana L.

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N2 - Background: Depression is associated with an increased risk for mortality after acute myocardial infarction (MI). The purpose of this study was to determine whether low heart rate variability (HRV) mediates the effect of depression on mortality. Methods: Twenty-four-hour ambulatory electrocardiograms were obtained from 311 depressed patients with a recent acute MI who were enrolled in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial and from 367 nondepressed patients who met the ENRICHD medical inclusion criteria. Standard HRV indexes were extracted from the recordings. Results: The log of very low-frequency (LnVLF) power, an index of HRV derived from power spectral analysis of the electrocardiogram signal (0.0033-0.04 Hz [in milliseconds squared]), was lower in the depressed than in the nondepressed patients (P<.001). There were 47 deaths (6.1%) during a 30-month follow-up. After adjusting for potential confounders, the depressed patients remained at higher risk for all-cause mortality compared with the nondepressed patients (hazard ratio, 2.8; 95% confidence interval [CI], 1.4-5.4; P<.003). When LnVLF power was entered into the model, the hazard ratio for depression dropped to 2.1 (95% CI, 1.1-4.2; P=.03). The proportion of the risk for depression attributable to LnVLF power was 0.27 (95% CI, 0.23-0.31; P<.001). Conclusions: Low HRV partially mediates the effect of depression on survival after acute MI. This finding helps to clarify the physiological mechanisms underlying depression's role as a risk factor for mortality in patients with coronary heart disease. It also raises the possibility that treatments that improve both depression and HRV might also improve survival in these patients.

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