Prevention of depression and anxiety in patients with acute coronary syndrome (DECARD)

Abstract

Background and Aims:Prevalence of depression and anxiety in patients recovering from acute coronary syndrome (ACS) i.e., myocardial infarction and unstable angina is higher than in general population and both depression and anxiety are associated with poor cardiac outcomes and higher mortality. Despite the prognostic role of post-ACS depression no clinical trials of prevention of depression and anxiety in this population of patients has been undertaken. The aim of the study is to evaluate the efficacy of preventive treatment with SSRI (escitalopram) in the first year after ACS.Methods:234 non-depressed patients will be enrolled within 8 weeks after ACS and will be randomly assigned to treatment with escitalopram/placebo (5-20 mg) in 52 weeks. There will be 9 psychiatric and 3 cardiologic assessments during the year of the study. Primary outcome measures are the diagnosis of depression and HDS (Hamilton Depression Scale). Psychiatric measurements: SCAN (Schedules for Clinical Assessment in Neuropsychiatry), HDS, HAS (Hamilton Anxiety Rating Scale), UKU Side Effect Rating Scale, ESSI (ENRICHD Social Support Instrument), SF-36 (SF-36 Health Survey), SCL-92 (Symptom Check List) and BDI (Beck Depression Inventory). Cardiologic measurements are blood pressure, electrocardiography, echocardiography (left ventricular ejection fraction), heart rate variability and use of medicine.Conclusion:ACS patients with mental illness often remain untreated with an increased risk of somatic comorbidity and mortality. DECARD study is the first study evaluating the effect of prophylactic treatment of depression in patients with ACS. The study is ongoing and on 15th October 2007 there were 216 patients enrolled.