Abstract
BackgroundThe prevalence of depression in patients with acute coronary syndrome, i.e. myocardial infarction and unstable angina, is higher than in the general population. The prevalence of anxiety is higher as well. Both depression and anxiety are associated with poor cardiac outcomes and higher mortality. Comorbid depression in patients with acute coronary syndrome often goes undiagnosed, and it is therefore a challenging task to prevent this risk factor. The study of DEpression in Coronary ARtery Disease (DECARD) is designed to examine if it is possible to prevent depression in patients with acute coronary syndrome.MethodsTwo hundred forty non-depressed patients with acute coronary syndrome are randomized to treatment with either escitalopram or placebo for 1 year. Psychiatric and cardiac assessment of patients is performed to evaluate the possibility of preventing depression. Diagnosis of depression and Hamilton Depression Scale are the primary outcome measures.DiscussionThis is the first study of prevention of depression in patients after acute coronary syndrome with a selective serotonin reuptake inhibitor.Trial Registration Identifier: NCT00140257
Highlights
The prevalence of depression in patients with acute coronary syndrome, i.e. myocardial infarction and unstable angina, is higher than in the general population
Diagnosis of depression and Hamilton Depression Scale are the primary outcome measures. This is the first study of prevention of depression in patients after acute coronary syndrome with a selective serotonin reuptake inhibitor
The prevalence of depression in patients recovering from acute coronary syndrome (ACS) defined as acute myocardial infarction (AMI) and unstable angina pectoris (UAP) has been reported to be 10–40% [1,2,3,4,5]
Summary
Overview The DEpression in Coronary ARtery Disease (DECARD) study is an investigator-initiated and driven study and 240 non-depressed patients with ACS are enrolled. Psychiatric assessment After demographic data collection during the baseline visit, SCAN is administrated using selected chapters regarding depression and anxiety (Part I, Chapters 3, 4, 6, 7, 8 and 21) This semi-structured diagnostic interview is used to exclude depression in patients entering the study. Cardiac assessment Cardiac evaluation is performed at baseline, weeks 26 and 52 at the end of treatment and includes information of risk factors for cardiovascular disease (smoking, diabetes, history of arterial hypertension, family history of CAD, physical activity), alcohol consumption, and current medications. 6. utilization of health services during the study period; Sample size, data analysis and statistical methods Sample size is calculated on the basis of the assumption, that 30% of patients the first year after ACS will develop a moderate or severe depressive episode [46] which can be reduced to 15% by SSRI treatment. During the study period no significant changes in the guidelines for treatment of patients with ACS took place
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