Comparison of Depression Interventions After Acute Coronary Syndrome: Quality of Life - CODIACS-QoL

Oct 22, 2019
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
National Heart, Lung, and Blood Institute
Date Presented:
03/16/2019
Date Published:
10/21/2019
Date Updated:
10/22/2019
Original Posted Date:
03/16/2019
References

Contribution To Literature:

The CODIACS-QoL trial failed to show that screening for depression after acute coronary syndrome was beneficial. 

Description:

The goal of the trial was to evaluate depression screening compared with no screening among patients with recent acute coronary syndrome.


Study Design

  • Randomized
  • Parallel

Patients with recent acute coronary syndrome were randomized to depression screening/notification of results/treatment (n = 499) versus depression screening/notification of results (n = 501) versus no screening (n = 500).

  • Total number of enrollees: 1,500
  • Duration of follow-up: 18 months
  • Mean patient age: 66 years
  • Percentage female: 28%

Inclusion criteria:

  • Patients ≥21 years of age with acute coronary syndrome within the last 2-12 months

Exclusion criteria:

  • Prior or current depression
  • Limited life expectancy
  • Severe mental illness
  • Severe physical illness
  • Dementia
  • Pregnancy

Other salient features/characteristics:

  • Positive screen for depression: 7.7% of the screen/notify/treat group and 6.6% of the screen/notify

Principal Findings:

The primary outcome of change in quality-adjusted life-years from baseline to 18 months, was -0.06 for screen/notify/treat group versus -0.06 for screen/notify group versus -0.06 for no screen group (p = 0.98).

Secondary outcomes:

  • Cumulative mean depression-free days: 343.1 for screen/notify/treat group versus 351.3 for screen/notify group versus 339.0 for no screen group (p = 0.63)
  • No difference in mortality at 18 months between the three groups (p = not significant)

Interpretation:

Among patients with recent acute coronary syndrome, screening for depression was not beneficial. This intervention failed to improve quality-adjusted life-years or depression-free days compared with no screening. Approximately 6-7% of individuals screened positive for depression. Depression screening guidelines may need to be reconsidered.


References:

Kronish IM, Moise N, Cheung YK, et al. Effect of Depression Screening After Acute Coronary Syndromes on Quality of Life: The CODIACS-QoL Randomized Clinical Trial. JAMA Intern Med 2019;Oct 21:[Epub ahead of print].

Presented by Dr. Ian Matthew Kronish at the American College of Cardiology Annual Scientific Session (ACC 2019), New Orleans, LA, March 16, 2019.

Keywords: ACC Annual Scientific Session, ACC19, Acute Coronary Syndrome, Depression, Depressive Disorder, Quality of Life, Primary Health Care, Primary Prevention, Quality-Adjusted Life Years, Treatment Outcome


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