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.
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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