Abstract
To investigate the impacts of depression screening, diagnosis and treatment on major adverse cardiac events (MACEs) in acute coronary syndrome (ACS). Prospective cohort study including a nested 24-week randomised clinical trial for treating depression was performed with 5-12 years after the index ACS. A total of 1152 patients recently hospitalised with ACS were recruited from 2006 to 2012, and were divided by depression screening and diagnosis at baseline and 24-week treatment allocation into five groups: 651 screening negative (N), 55 screening positive but no depressive disorder (S), 149 depressive disorder randomised to escitalopram (E), 151 depressive disorder randomised to placebo (P) and 146 depressive disorder receiving medical treatment only (M). Cumulative MACE incidences over a median 8.4-year follow-up period were 29.6% in N, 43.6% in S, 40.9% in E, 53.6% in P and 59.6% in M. Compared to N, screening positive was associated with higher incidence of MACE [adjusted hazards ratio 2.15 (95% confidence interval 1.63-2.83)]. No differences were found between screening positive with and without a formal depressive disorder diagnosis. Of those screening positive, E was associated with a lower incidence of MACE than P and M. M had the worst outcomes even compared to P, despite significantly milder depressive symptoms at baseline. Routine depression screening in patients with recent ACS and subsequent appropriate treatment of depression could improve long-term cardiac outcomes.
Highlights
Depression is common in acute coronary syndrome (ACS) including myocardial infarction (MI) and unstable angina
major adverse cardiac events (MACEs) occurrences according to depression screening and diagnosis status In 2017, all participants were followed for 5–12 years or until they died [median; mean (S.D.) follow-up = 8.4; 8.7 (1.5) years]
Participants screening positive for depressive disorder had significantly higher hazards of composite and all individual MACE components except for MI compared to those screening negative after full adjustment
Summary
Depression is common in acute coronary syndrome (ACS) including myocardial infarction (MI) and unstable angina. Shortly afterward, a systematic review found no evidence for or against the recommendations that depression should be evaluated or that screening for depression should be considered as part of standard care in patients with ACS (Thombs et al, 2008). This argument was strongly influenced by the lack of evidence for significant beneficial effects of antidepressant or cognitive behavioural treatment for depression on long-term cardiac outcomes in patients with ACS (Berkman et al, 2003; Glassman, Bigger, & Gaffney, 2009; van Melle et al, 2007). Routine depression screening in patients with recent ACS and subsequent appropriate treatment of depression could improve long-term cardiac outcomes
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