Can Doctors and Nurses Recognize Depression in Patients Hospitalized With an Acute Myocardial Infarction in the Absence of Formal Screening?

Ziegelstein, Roy C.; Kim, So Young; Kao, David; Fauerbach, James A.; Thombs, Brett D.; McCann, Una D.; Colburn, Jessica L.; Bush, David E.

doi:10.1097/01.psy.0000160475.38930.8d

Cited by 87 publications

(72 citation statements)

References 27 publications

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“…This is probably due to the fact that formal screening for depression is not a part of the routine care for patients with chest pain and therefore depression can go unrecognized by cardiovascular physicians and nurses. 46 At follow-up we also found 26 new patients with depressive symptoms compared to 17 17 who had no depressive symptoms any more. One explanation could be that having recurrent and inadequately treated chest pain for a long time, without knowing the cause could lead to worries and depressive symptoms in NCCP and AP patients.…”

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confidence: 65%

Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease

et al. 2012

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OBJECTIVES: We compared depressive symptoms and healthcare utilization in patients admitted for noncardiac chest pain, acute myocardial infarction, and angina pectoris after hospitalization and at 1-year follow-up. METHODS: One hundred and thirty-one patients with noncardiac chest pain, 66 with acute myocardial infarction, and 70 with angina pectoris completed a depression screening questionnaire and the Montgomery Åsberg Depression Rating Scale. Healthcare utilization data were collected from a population-based, diagnosis-related database. RESULTS: More than 25% of respondents reported depressive symptoms, regardless of diagnosis. At follow-up, 9% had recovered, 19% were still experiencing depressive symptoms, and 13% had developed depressive symptoms. Noncardiac patients with chest pain had similar primary care contacts, but fewer hospital admissions, than patients with an acute myocardial infarction. Patients with angina pectoris and depressive symptoms used the most healthcare services. CONCLUSIONS: Depressive symptoms were common. Patients with noncardiac chest pain used as much primary care as did patients with an acute myocardial infarction. Interventions should focus on identifying and treating depressive symptoms

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confidence: 65%

Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease

et al. 2012

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“…[1][2][3] Depressive symptoms are associated with adverse cardiovascular outcomes, independent of traditional risk factors and cardiac disease severity. 4 -6 Given the public health burden of depression and its associated poor prognosis, along with the poor rate of recognition in patients with heart conditions, [7][8][9] the American Heart Association (AHA) has recommended routine screening for depression in all patients with CHD, using a 2-step screening method. 10 The first step consists of the administration of a yes/no version of the 2-item Patient Health Questionnaire (PHQ-2).…”

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confidence: 99%

Accuracy and Prognostic Value of American Heart Association–Recommended Depression Screening in Patients With Coronary Heart Disease

Elderon

Smolderen

et al. 2011

Circ: Cardiovascular Quality and Outcomes

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recommended a 2-step screening method, consisting of the 2-item Patient Health Questionnaire (PHQ-2) followed by the 9-item Patient Health Questionnaire (PHQ-9), for identifying depression in cardiovascular patients. The accuracy and prognostic value of this screening method have not been evaluated. Methods and Results-We administered the 2-step AHA-recommended screening algorithm to 1024 patients with stable coronary heart disease and calculated sensitivity and specificity against a gold standard interview for major depressive disorder. Subsequent cardiovascular events (myocardial infarction, stroke, transient ischemic attack, heart failure, or death) were determined during a mean of 6.27Ϯ2.11 years of follow-up. The AHA-recommended screening method had high specificity (0.91; 95% confidence interval, 0.89 to 0.93) but low sensitivity (0.52; 95% confidence interval, 0.46 to 0.59) for a diagnosis of major depressive disorder. Participants who screened positive on the AHA depression protocol had a 55% greater risk of events than those who screened negative (age-adjusted hazard ratio, 1.55; 95% confidence interval, 1.21 to 1.97; Pϭ0.0005). After adjustment for age, sex, body mass index, history of myocardial infarction, hypertension, diabetes, heart failure, and high-density lipoprotein levels, screening positive remained associated with a 41% greater rate of cardiovascular events (hazard ratio, 1.41; 95% confidence interval, 1.10 to 1.81; Pϭ0.008). Conclusions-Among outpatients with stable coronary heart disease, the AHA-recommended depression screening protocol is highly specific for depression and identifies patients at risk for adverse cardiovascular outcomes. (Circ Cardiovasc Qual Outcomes. 2011;4:533-540.)

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“…[1][2][3] Antidepressant medication and psychotherapeutic treatment of depression have both been found to be safe and effective in patients with various forms of heart disease, 4,5 but rates of depression recognition and treatment in such patients are exceedingly low. 6,7 Collaborative care depression management programswhich use a nonphysician care manager to coordinate depression evaluation and treatment among patient, primary medical physician, and psychiatrist-have been used in outpatient settings to effectively (and cost-effectively) reduce depression and improve associated outcomes. 8,9 Among patients with acute cardiovascular disease, this model has been successfully used in depressed patients who were recently discharged after undergoing coronary artery bypass graft surgery.…”

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confidence: 99%

Impact of a Depression Care Management Program for Hospitalized Cardiac Patients

Huffman

Mastromauro²,

Sowden³

et al. 2011

Circ: Cardiovascular Quality and Outcomes

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Background— Depression is independently associated with poor outcomes among patients with acute cardiac disease. Collaborative care depression management programs have been used in outpatients to improve depression outcomes, but such a program had never been initiated in the hospital or used for patients with a wide range of cardiac illnesses. Methods and Results— This was a prospective, randomized trial of a low-intensity, 12-week collaborative care program versus usual care for 175 depressed patients hospitalized for acute coronary syndrome, arrhythmia, or heart failure. Study outcomes, assessed using mixed regression models to compare groups at 6 weeks, 12 weeks, and 6 months, included mental health (depression, cognitive symptoms of depression, anxiety, and mental health-related quality of life) and medical (physical health-related quality of life, adherence to medical recommendations, and cardiac symptoms) outcomes. Collaborative care subjects (n=90) had significantly greater improvements on all mental health outcomes at 6 and 12 weeks, including rates of depression response (collaborative care, 59.7% versus usual care 33.7%; odds ratio, 2.91; P =0.003 at 6 weeks; 51.5% versus 34.4%; odds ratio, 2.02; P =0.04 at 12 weeks), though these effects decreased after intervention. At 6 months, intervention subjects had significantly greater self-reported adherence and significantly reduced number and intensity of cardiac symptoms. Conclusions— Among patients with a broad range of cardiac diagnoses, a collaborative care depression management program initiated during hospitalization led to significant improvements in multiple clinically important mental health outcomes and had promising effects on relevant medical outcomes after intervention. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00847132.

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Can Doctors and Nurses Recognize Depression in Patients Hospitalized With an Acute Myocardial Infarction in the Absence of Formal Screening?

Abstract: Cardiovascular nurses and medicine residents and interns underrecognize depression in patients with AMI in the absence of formal screening. Formal screening for symptoms of depression should be considered part of routine AMI care.

Cited by 87 publications

References 27 publications

Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease

Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease

Accuracy and Prognostic Value of American Heart Association–Recommended Depression Screening in Patients With Coronary Heart Disease

Impact of a Depression Care Management Program for Hospitalized Cardiac Patients

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