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

Contribution To Literature:

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


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)


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.


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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