Screening, referral and treatment for depression in patients with coronary heart disease

Abstract

In 2003, the National Heart Foundation of Australia position statement on "stress" and heart disease found that depression was an important risk factor for coronary heart disease (CHD). This 2013 statement updates the evidence on depression (mild, moderate and severe) in patients with CHD, and provides guidance for health professionals on screening and treatment for depression in patients with CHD. The prevalence of depression is high in patients with CHD and it has a significant impact on the patient's quality of life and adherence to therapy, and an independent effect on prognosis. Rates of major depressive disorder of around 15% have been reported in patients after myocardial infarction or coronary artery bypass grafting. To provide the best possible care, it is important to recognise depression in patients with CHD. Routine screening for depression in all patients with CHD is indicated at first presentation, and again at the next follow-up appointment. A follow-up screen should occur 2-3 months after a CHD event. Screening should then be considered on a yearly basis, as for any other major risk factor for CHD. A simple tool for initial screening, such as the Patient Health Questionnaire-2 (PHQ-2) or the short-form Cardiac Depression Scale (CDS), can be incorporated into usual clinical practice with minimum interference, and may increase uptake of screening. Patients with positive screening results may need further evaluation. Appropriate treatment should be commenced, and the patient monitored. If screening is followed by comprehensive care, depression outcomes are likely to be improved. Patients with CHD and depression respond to cognitive behaviour therapy, collaborative care, exercise and some drug therapies in a similar way to the general population. However, tricyclic antidepressant drugs may worsen CHD outcomes and should be avoided. Coordination of care between health care providers is essential for optimal outcomes for patients. The benefits of treating depression include improved quality of life, improved adherence to other therapies and, potentially, improved CHD outcomes.

The lived experiences of patients post coronary angioplasty: A qualitative study

“…25 Ongoing monitoring and screening of patients for psychological distress and offering supportive interventions such as counselling and treatment may help patients to cope effectively with various aspects of their disease, develop more realistic goals for their life, and take actions to reduce their future risk. 25,40 This study focused only on patients' experiences after coronary angioplasty; future research is recommended to study patients' reaction to angioplasty when it is used for blood vessels other than coronary arteries.…”

Psychological Aspects of Cardiac Care and Rehabilitation: Time to Wake Up to Sleep?

“…For example, cognitive behavioural therapy (CBT), Interpersonal psychotherapy (IPT), and problem-solving therapy (PST) have all been shown to be beneficial for depression in cardiac patients but did not affect cardiac endpoints [21,93,96]. Currently, collaborative care, or stepped care, is considered to be optimal in treating cardiac patients with depressed mood [94,95]. The COPES trial employed a stepped-care treatment approach in patients with ACS and persistent depression, involving an initial patient choice of PST and/or pharmacotherapy [96].…”

“…However a large proportion of CR programmes do not routinely screen for depression [102], and screening itself does not necessarily translate into improved clinical outcomes for cardiac patients unless followed by comprehensive care [94,102]. It is recommended that clinically significant levels of depression be systematically identified via clinical interview and/or use of a brief, reliable screening measure validated in cardiac populations (e.g.…”

Anxiety in patients with acute coronary syndromes

“…Rates of major depressive disorder of near 15% have been found in patients with acute coronary disease. Recently, the EUROASPIRE III study on 8580 patients after hospitalization for coronary heart disease revealed that the proportion of patients with depression, measured by the Hospital Anxiety and Depression Scale, varied from 8.2 -35.7% in men and 10.3 -62.5% in women 1,2 .…”