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Effect of Depression Screening After ACS
Study Questions:
Does depression screening after acute coronary syndrome (ACS) events improve quality of life (QOL) and depression?
Methods:
The CODIACS-QoL (Comparison of Depression Interventions After Acute Coronary Syndrome: Quality of Life) trial sought to examine the potential benefit of systematic depression screening with or without treatment among patients with recent ACS. A randomized controlled study design was used to examine the efficacy of systematic depression screening using the Patient Health Questionnaire (PHQ), with notification of results to primary care providers and provision of a centralized, patient preference, stepped depression care for those who screened positive for depression. Two comparator arms included: 1) systematic depression screening with notification of primary care providers (but not stepped care), and 2) usual care (no screening). A score of ≥10 on the PHQ was considered having depression. The primary outcome included change in quality-adjusted life-years. Secondary outcomes included depression-free days, adverse events, and mortality. Follow-up continued to 18 months post-enrollment.
Results:
A total of 5,332 patients were identified as potentially eligible for depression screening by electronic medical record review, of which 4,039 were contacted by telephone. Of these, 2,130 declined participation in the study, 408 were not eligible, and one withdrew. A total of 1,500 patients (424 women, mean age 65.9 years) were randomized to one of three groups in a 1:1:1 fashion. Only 71 of the 1,000 eligible survivors met criteria for depression by PHQ scores at the time of screening. There were no differences in mean change in quality-adjusted life-years between the three groups (p = 0.98). No differences were noted in depression-free days between the three groups (p = 0.63). Adverse events including death, bleeding, and sleep difficulties were also not different between groups.
Conclusions:
Among patients with ACS without a prior history of depression, systematic depression screening with or without treatment did not alter quality-adjusted life-years, depression-free days, or adverse events.
Perspective:
Trials such as these are difficult, as lack of blinding can impact results. Furthermore, as the authors note, the rate of potential participants who declined participation was large. Given that prior studies suggest high rates of depression in ACS patients, other methods for identification of ACS patients who would benefit from depression care and screening are warranted.
Keywords: Acute Coronary Syndrome, Depression, Depressive Disorder, Electronic Health Records, Myocardial Ischemia, Primary Health Care, Primary Prevention, Quality of Life, Quality-Adjusted Life Years, Treatment Outcome
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