Abstract 308: Predictors of Depression Recognition and Site Variability in Depression Recognition in Young AMI Survivors

Abstract

Background: Depression among acute myocardial infarction (AMI) survivors is common and associated with adverse outcomes in the year following their AMI. In young women and men, about 1 in 3 patients suffer from depressive symptoms following their AMI. Early depression recognition is important to ensure timely treatment, and potentially improve outcomes. It is unknown, however, how well providers recognized potential depression in young AMI patients, what patient factors are associated with recognition, and how much variation there is across centers. Methods: VIRGO is a multi-center, international, prospective observational study that enrolled 3,350 AMI patients aged 18-55 years (67.1% women) between 2008-2012. During the index hospitalization for AMI, the Patient Health Questionnaire [PHQ-9] was administered to collect depressive symptoms experienced over the past 2 weeks (cut-off score ≥10 indicated potential depression). Demographic, socio-economic, cardiovascular risk, AMI-severity, and depression treatment data were collected through patient interviews and chart abstraction. Depression recognition was defined as having PHQ-9 scores ≥10 and receiving depression treatment (anti-depressants and/or counseling referral) at discharge and/or at 1-month follow-up. Results: During AMI admission, 1,057 (32%) patients had PHQ-9 scores ≥10. Overall, 41% were recognized by their providers. Independent predictors of having patients’ depressive symptoms recognized were: having health insurance (OR=1.46, CI95% 1.03-2.06), history of lung disease (OR=2.02, CI95% 1.36-2.99), and a higher PHQ-9 score (OR=1.06, CI95% 1.03-1.10). African Americans (OR=0.34, CI95% 0.21-0.54), males (OR=0.52, CI95% 0.37-0.74) and married patients (OR=0.72, CI95% 0.54-0.95) were less likely to be recognized. Recognition rates by AMI treating facility (Figure) ranged from 15 to 60%, with a median OR of 1.25 (CI = 1.00, 1.61). Conclusion: Depression recognition rates are poor in young AMI patients with substantial variation observed across AMI treating facilities. Males, African Americans, and uninsured patients are less often recognized and may continue to be at risk of poor AMI outcomes.