Correspondence

Long-Term Outcomes after Successful Early Defibrillation

N Engl J Med 2003; 349:1777October 30, 2003

Article

To the Editor:

Bunch and colleagues (June 26 issue)1 note that the quality of life of survivors after out-of-hospital cardiac arrest was, in most respects, similar to that of the general population. Patients who have undergone treatment after a life-threatening event or who have undergone major surgery may and often do have anxiety or depression months to years after the event.2 Moreover, the effects of drugs on the quality of life of patients with cardiovascular diseases are important considerations for health care professionals.3,4 One limitation of this study that should be addressed is the possible use by the patients of anxiolytic agents, antidepressants, or other medications, including antihypertensive drugs, which can affect their responses to the Medical Outcomes Study 36-Item Short-Form General Health Survey.

Nicola C. Ho, M.D.
National Institutes of Health, Baltimore, MD 21224
honi@grc.nia.nih.gov

4 References

1. 1

   Bunch TJ, White RD, Gersh BJ, et al. Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 2003;348:2626-2633
   Full Text | Web of Science | Medline

2. 2

   Rymaszewska J, Kiejna A, Hadryg T. Depression and anxiety in coronary artery bypass grafting patients. Eur Psychiatry 2003;18:155-160
   CrossRef | Web of Science | Medline

3. 3

   Croog SH, Levine S, Testa MA, et al. The effects of antihypertensive therapy on the quality of life. N Engl J Med 1986;314:1657-1664
   Full Text | Web of Science | Medline

4. 4

   Wenger NK, Mattson ME, Furberg CD, Elinson J. Assessment of quality of life in clinical trials of cardiovascular therapies. Am J Cardiol 1984;54:508-513
   CrossRef | Web of Science | Medline

Author/Editor Response

We agree with Dr. Ho that both anxiety and depression are associated with an adversely affected quality of life after cardiac events.1 In addition, depression is a long-term risk factor in patients with cardiac disease — in particular, after myocardial infarction — for recurrent cardiovascular events and death.2,3 It is uncertain whether antidepressive therapy will improve cardiac outcomes in patients with depression after myocardial infarction.3 Antihypertensive therapy may also have effects on the quality of life, which may vary within populations.4,5

In our study, 3 of 79 neurologically intact survivors of out-of-hospital cardiac arrest (4 percent) were discharged while receiving antidepressant therapy, and no patient was receiving an anxiolytic agent. The use of antihypertensive medications was prevalent at hospital discharge (beta-blockers in 43 patients [54 percent], angiotensin-converting–enzyme inhibitors in 37 patients [47 percent], angiotensin-receptor blockers in 2 patients [3 percent], calcium-channel blockers in 6 patients [8 percent], and diuretics in 16 patients [20 percent]). We do not have data on the frequency of use of these medications at the time that quality of life was evaluated. Careful assessment for depression and anxiety should be part of the evaluation of all patients with cardiovascular events. Potential side effects of therapy targeted to risk factors must be weighed in the context of the long-term benefits.

T. Jared Bunch, M.D.
Roger D. White, M.D.
Douglas L. Packer, M.D.
Mayo Clinic, Rochester, MN 55905
white.roger@mayo.edu

5 References

1. 1

   Sullivan MD, LaCroix AZ, Spertus JA, Hecht J. Five-year prospective study of the effects of anxiety and depression in patients with coronary artery disease. Am J Cardiol 2000;86:1135-1138
   CrossRef | Web of Science | Medline

2. 2

   Carney RM, Rich MW, Freedland KE, et al. Major depressive disorder predicts cardiac events in patients with coronary artery disease. Psychosom Med 1988;50:627-633
   Web of Science | Medline

3. 3

   van den Brink RH, van Melle JP, Honig A, et al. Treatment of depression after myocardial infarction and the effects on cardiac prognosis and quality of life: rationale and outline of the Myocardial INfarction and Depression-Intervention Trial (MIND-IT). Am Heart J 2002;144:219-225
   CrossRef | Web of Science | Medline

4. 4

   Fletcher AE, Bulpitt CJ, Thijs L, et al. Quality of life on randomized treatment for isolated systolic hypertension: results from the Syst-Eur Trial. J Hypertens 2002;20:2069-2079
   CrossRef | Web of Science | Medline

5. 5

   Croog SH, Levine S, Testa MA, et al. The effects of antihypertensive therapy on the quality of life. N Engl J Med 1986;314:1657-1664
   Full Text | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   Nicola C. Ho, Michael Guarnieri, Larry J. Brant, Susan S. Park, Bonnie Sun, Marisa North, Clair A. Francomano, Benjamin S. Carson. (2004) Living with achondroplasia: Quality of life evaluation following cervico-medullary decompression. American Journal of Medical Genetics 131A:2, 163-167
   CrossRef