Patients who were screened for depression and referred for treatment after a heart attack or unstable angina did not have a significant improvement in quality of life (QoL), according to results of the CODIACS-QoL trial presented by Ian Matthew Kronish, MD, et al., at ACC.19 in New Orleans.

Depression is a known risk factor for heart disease and can increase the risk of subsequent cardiac events and death if present after acute coronary syndrome (ACS). More than 1,500 patients hospitalized within the prior two to 12 month for ACS were randomly assigned to three groups – one group received no depression screening and the other two groups completed the Patient Health Questionnaire to identify depression. Patients in one of the latter groups and their primary care providers received notification of positive results and referral to depression treatment; the other group received notification but no referral to treatment.

Depression was identified in about 7 percent of screened patients. Changes in QoL based on quality-adjusted life years (QALYs) was assessed during 18-months follow-up, showing a very small decline and no significant difference between the three study groups. No significant difference was found between the groups in the cumulative number of depression-free days (339 to 351 days over 18 months). There was no significant difference in depressive symptoms at nine months, antidepressant adverse effects, or rates of death or bleeding. Approximately one-quarter of patients referred for depression treatment declined. Those who accepted received medications, phone-based psychotherapy or a combination of both.

"We hope this isn't the final word on this question and that others will look into different ways to identify heart attack survivors who could benefit from depression treatment," Kronish said. "In addition, we need to think about how we can improve our depression treatments to have a bigger benefit, which could make screening more worthwhile."

Keywords: ACC19, ACC Scientific Session Newspaper, Depression, Acute Coronary Syndrome, Quality of Life, Cost-Benefit Analysis, Depressive Disorder, Heart Failure, Secondary Prevention

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