Practice guidelines for cardiovascular disease: how is depression addressed?

Abstract

Abstract Introduction Multimorbidity is associated with increased mortality, decreased quality of life, and increased use of healthcare services and complicates medical decision-making. Depression is more prevalent among patients with CVD than in the general population, with a direct impact on cardiovascular outcomes and management. Clinical practice guidelines (CPGs) aim to provide the best available advice for improving patient care and outcomes. Question: Do CPGs on CVD provide any practical guidance on depression screening and management? Methods National and international CPGs on CVD prevention and management published between 2012 and 2023. English language only. Databases: MEDLINE n=2432. EMBASE n=327; G.I.N. n=57; Guideline Central: n=97; Uptodate n=26; Society homepages (e.g. NICE, SIGN) n=7. Selection criteria: general management guidelines for adult patients diagnosed with a CVD, as well as disease-specific CPGs (e.g. heart failure (HF), coronary artery disease, peripheral arterial disease (PAD), ischaemic disease, stroke or hypertension (HT)) providing patient-management guidance. Eligible guidelines: evaluated for any mention of depression, with a focus on: 1) recommendations regarding depression screening and treatment; 2) drug-drug or drug-disease interactions associated with depression. Results 43 CVD CPGs provide comprehensive management advice: 7 from CVD in general and 36 from specific disease in CVD (11 from HT, 7 from ischemic heart disease, 7 from HF, 5 from dyslipidemia, 3 from stroke, and 3 from PAD). 26 CVD CPGs mention depression as a CV comorbidity at least once: 22 in specific disease CPG and 4 in general CVD CPGs. 15 CVD CPGs advise to screen for depression: 4 from CVD in general and 11 from specific disease in CVD (4 from ischemic heart disease, 3 from HF, 2 from HT, 1 from PAD, and 1 from stroke). 8 CVD clinical practice guidelines provide advice on management of depression: 3 from CVD in general and 5 from specific disease (2 from HT, 2 from ischemic heart disease and 1 from HF). 4 CVD clinical practice guidelines advise on drug-drug or drug-disease interactions. When provided, the level and quality of guidance for treating physicians on how to screen and manage depression remains very low. Conclusion Management of CVD in the specific clinical setting of depression remains poorly addressed, despite it being documented that factors associated with poor adherence to CVD treatment include depression. Future directions: The psychosocial needs of patients with CVD should be systematically assessed and addressed in an evidence-based manner. There is a need for clear practical guidance on the frequency at which a patient’s mental health should be reassessed. Patient panels can help provide practical information toward addressing depression in the development of guidelines.The AIDS CPG address depression in detail and could serve as a model for future CVD CPGs.