Enhanced Depression Care for Patients With Acute Coronary Syndrome and Persistent Depressive Symptoms

Abstract

Background Depressive symptoms are an established predictor of mortality and major adverse cardiac events (defined as nonfatal myocardial infarction or hospitalization for unstable angina or urgent/emergency revascularizations) in patients with acute coronary syndrome (ACS). This study was conducted to determine the acceptability and efficacy of enhanced depression treatment in patients with ACS. Methods A 3-month observation period to identify patients with ACS and persistent depressive symptoms was followed by a 6-month randomized controlled trial. From January 1, 2005, through February 29, 2008, 237 patients with ACS from 5 hospitals were enrolled, including 157 persistently depressed patients randomized to intervention (initial patient preference for problem-solving therapy and/or pharmacotherapy, then a stepped-care approach; 80 patients) or usual care (77 patients) and 80 nondepressed patients who underwent observational evaluation. The primary outcome was patient satisfaction with depression care. Secondary outcomes were depressive symptom changes (assessed with the Beck Depression Inventory), major adverse cardiac events, and death. Results At the end of the trial, the proportion of patients who were satisfied with their depression care was higher in the intervention group (54% of 80) than in the usual care group (19% of 77) (odds ratio, 5.4; 95% confidence interval [CI], 2.2–12.9 [P<.001]). The Beck Depression Inventory score decreased significantly more (t155=2.85 [P=.005]) for intervention patients (change, −5.7; 95% CI, −7.6 to −3.8; df=155) than for usual care patients (change, −1.9; 95% CI, −3.8 to −0.1; df=155); the depression effect size was 0.59 of the standard deviation. At the end of the trial, 3 intervention patients and 10 usual care patients had experienced major adverse cardiac events (4% and 13%, respectively; log-rank test, χ12=3.93 [P=.047]), as well as 5 nondepressed patients (6%) (for the intervention vs nondepressed cohort, χ12=0.48 [P=.49]). Conclusion Enhanced depression care for patients with ACS was associated with greater satisfaction, a greater reduction in depressive symptoms, and a promising improvement in prognosis.

Neurobehavioral Functioning and Survival Following Lung Transplantation

“…9 Persistent depression, typically defi ned as depressive symptoms that remain elevated over the course of several months, 10 has been associated with increased mortality following coronary artery bypass grafting . 11 Lower cognitive function, which is typically measured by performance on tests of memory, attention, and concentration, 12 has been associated with increased mortality in epidemiologic studies of primary care patients 13,14 and among cardiac patients, 15 but has not been examined as a predictor of outcomes following lung transplantation.…”

Sex Differences in Depression Treatment and Impact on Outcomes Following Premature Acute Coronary Syndrome

“…For example, medical personnel can refer to a review by Lespérance and FrasureSmith to learn about tools to screen for depression in ACS patients, as well as how to distinguish between ACS and depressive symptoms [9]. Depression is a psychiatric disease that deserves its own treatment, at the least to relieve patients' distress and improve daily functioning, irrespective of heart disease treatment [18][19][20].…”

Agomelatine in the Treatment of Anxiety and Depressive Disorders in Patients With Ischemic Heart Disease

“…На сегодняшний день есть только ограниченные данные рандомизированных исследо-ваний, указывающие на эффективное снижение сер-дечно-сосудистого риска, заболеваемости и смертно-сти на фоне терапии антидепрессантами, в целом же из-за малого количества исследований эффектив-ность лечения антидепрессантами больных ИБС оста-ется неопределенной [28][29][30]. Необходимы большие клинические исследования, посвященные определе-нию оптимальной терапии пациентов с ИБС и тревожно-депрессивными расстройствами.…”