Abstract 13067: Depression and 5-Year Stroke Risk in Patients With Atrial Fibrillation

Abstract

Introduction: Stroke is a leading cause of death and permanent disability in patients with Atrial Fibrillation (AF). Depression is highly prevalent and previous studies have suggested that it is associated with a significantly increased risk of stroke morbidity and mortality in the general population. Here, we report the impact of depressive mood on the risk of stroke among patients with AF. Hypothesis: Depression increases the risk of stroke among patients with AF. Methods: We enrolled 5976 patients diagnosed with AF at the hospitals and clinics of the University of Pittsburgh Medical Center from January 2006 to November 2013. Depression status was determined by chart review of physicians’ diagnoses. Stroke incidence in each group is summarized with Kaplan-Meier curves; Cox proportional-hazards models were used to assess the relationship between depression and stroke risk when accounting for potential confounders. Results: Of the 5976 patients, 681 (11.4%) had diagnosis of depression. Patients were followed for a median of 39 months (range 1-60), during which there were 200 total strokes (35 in patients with depression). Risk of stroke was higher in patients with diagnosed depression (7.5% vs 4.7%, HR=1.70, 95% CI: 1.18-2.45, p=0.004, Figure). Even after controlling for several known stroke risk factors (age, sex, alcohol and tobacco use, congestive heart failure, previous stroke, diabetes, hypertension, vascular diseases, COPD and anticoagulant use), depressed patients had higher incidence of stroke (HR=1.45, 95% CI 0.99-2.11, p=0.054). Conclusion: Diagnosis of depression is associated with increased risk of ischemic stroke in patients with Atrial Fibrillation. Clinical trials remain necessary to establish whether screening AF patients for depression and then providing effective anti-depressive treatment can reduce the incidence of stroke and improve clinical outcomes.