Major Depression Was not Found to be Associated with a Higher Rate of Myocardial Infarction Using a Large Inpatient Database

Abstract

Importance: In 2014, the American Heart Association issued a statement proposing that depression be recognized as a risk factor for increased mortality from myocardial infarction (MI), but noted further research is needed. However, most studies that concluded this association evaluated depression after the occurrence of heart disease.

Objective: To evaluate any association between depression and myocardial infarction using a large inpatient database.

Design: Retrospective study using the Nationwide Inpatient Sample (NIS) database in the U.S. from 2005 to 2020. Patients discharged from hospitals using the NIS and ICD-9 and ICD-10 codes consistent with depression and acute MI. IBM SPSS Statistics 25.0 was applied to data. Demographics, clinical details, and hospital features were presented with 95% confidence intervals. Chi-squared and univariate linear regression for trend analysis. Multivariable logistic regression determined odds for binary clinical outcomes considering patient and hospital characteristics, and temporal evolution. Analyses incorporated population discharge weights, with statistical significance set at p ≤ 0.05

Setting: Hospitals that use the NIS database ICD codes. Database is publicly available and is the largest all-payer inpatient care database in the US from the Healthcare Cost and Utilization Project (HCUP). Its data are used to analyze national trends in healthcare utilization, healthcare quality, and patient outcomes. www.hcup-us.ahrq.gov.

Participants: Inclusion criteria: adults aged 30 and above (exclusion < 30), discharged from hospitals using the NIS. Included 4,413,113 STEMI (mean age of 67) patients, 224,430 with depression, and 10,421,346 NSTEMI patients (mean age 69), including 437,058 NSTEMI with depression.

Exposure: Is depression associated with a higher rate of myocardial infarction (STEMI & Non-STEMI) in adults 30 and over? We hypothesize that there will be a positive correlation between depression and myocardial infarction.

Main Outcome and Measure: Primary outcomes: Myocardial Infarction (STEMI and non-STEMI)

Results: We did not find any significant association between depression and myocardial infarction. Interestingly MI including STEMI and NSTEMI occurred to a lesser degree in patients with a diagnosis of depression. Our data showed this as a consistent trend over 15 15-year period. For instance, in 2005, within the depression STEMI group, the odds ratio (OR) was 0.12, with a 95% confidence interval (CI) of 0.10-0.15, and a p < 0.001. In 2020, the depression STEMI OR was 0.71, with a 95% CI of 0.69-0.73, and a p < 0.001. A similar pattern was observed within the NSTEMI group. The 2005 NSTEMI depression OR was 0.14, with a 95% CI of 0.13-0.16, p-value < 0.001. In 2020, the NSTEMI depression OR was 0.69, with a 95% CI of 0.68-0.71, p-value < 0.001.

Conclusions and Relevance: Our study did not identify an increased association between myocardial infarction and major depression. The results suggest that depression may not independently be a significant risk factor for myocardial infarction. Prospective cohort or intervention studies are necessary to elucidate the cause-and-effect relationships between depression, anxiety, and cardiac events. Future studies should delve into the specifics of depression treatment, including dosages and types of medications, to provide a clearer picture of how these factors influence MI prevalence. The implications are far-reaching, and our findings should serve as a catalyst for a deeper understanding of the complex connections between mental health and heart health.