Objectives: The objective of this study was to investigate the association between depression and mortality in older adults undergoing endovascular or open interventions for peripheral arterial disease (PAD). Method(s): This was a preplanned analysis of the FRaily Assessment In Lower Extremity arterial Disease (FRAILED) prospective cohort study including two centers in Montreal, Canada, designed to examine frailty in patients with PAD. Consecutive patients undergoing endovascular or open interventions for PAD (Rutherford class >=3) were enrolled. Depression was assessed before the intervention using the 15-item Geriatric Depression Scale Short Form, with a score >5 being consistent with depression. The primary outcome was all-cause mortality at 6 months. The secondary outcomes were readmission or need for reintervention. Result(s): Among 149 older adults with a mean age of 70.3 +/- 11.1 years, 54.7% received endovascular interventions and 45.3% received open interventions. The prevalence of screened depression was 28.4% (n = 42), whereas this had been documented in only 3.3% (n = 5) of patients in the clinical record. Among those who were depressed, 27.2% received endovascular interventions and 29.9% received open interventions. The incidence of all-cause mortality was 10.0% (n = 15) in the depressed group and 1.3% (n = 2) in the nondepressed group. Univariate analysis demonstrated that depressive symptoms were associated with low appetite, weight loss, and anemia. After adjusting for age, sex, predicted operative risk with the revised cardiac risk index, and procedure type, worsening depression scores were found to be independently predictive of 6-month mortality (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.08-2.29), but not of vascular reintervention (OR, 1.11; 95% CI, 0.99-1.26) or readmission (OR, 1.16; 95% CI, 0.96-1.39). Conclusion(s): Depression is underdiagnosed in older adults undergoing endovascular or open interventions for PAD. Worsening depression scores using the Geriatric Depression Scale Short Form were found to be predictive of all-cause mortality 6-months after the intervention. The effect of depression on mortality did not appear to be mediated by a higher risk of reintervention or readmission.
Drudi, L. M., Boudrias, C., Ades, M., Mancini, R., Grenon, M., Steinmetz, O., & Afilalo, J. (2017). PC124 Depression in Older Adults Undergoing Interventions for Peripheral Arterial Disease. Journal of Vascular Surgery, 65(6), 173S. https://doi.org/10.1016/j.jvs.2017.03.327