News | September 30, 2008

AHA Recommends Heart Patients be Screened for Depression

October 1, 2008 - The American Heart Association recommends heart patients be screened for depression, based on studies that show depression is about three times more common in patients following a heart attack than in the general community.
The Association's first scientific statement on depression and coronary heart disease was published in Circulation: Journal of the American Heart Association.
The recommendations, which are endorsed by the American Psychiatric Association, include:
- early and repeated screening for depression in heart patients;
- the use of two questions to screen patients - if depression is suspected the remaining questions are asked (9 questions total);
- coordinated follow-up for both heart disease and depressive symptoms in patients who have both.

"The statement was prompted by the growing body of evidence that shows a link between depression in cardiac patients and a poorer long-term outlook," said Erika Froelicher, R.N., M.A., M.P.H., Ph.D., a professor at the University of California San Francisco, School of Nursing and Medicine and co-chair of the writing group.
Dale Briggs, who experienced depression after his heart valve surgery, said the statement is welcome news. "I think it's long overdue. It is unfortunate that some patients aren't warned of the possibility of some depression after surgery," he said.
Briggs is the volunteer executive vice president of Mended Hearts Inc., a national nonprofit organization affiliated with the heart association, offering resources and support for heart surgery patients.
"Since my surgery, I've visited about 1,000 patients. During a visit I always let patients know that this may happen, and encourage them to talk to their doctor about getting treatment," he said. "I've had a number of people call me through the years and thank me for warning them about the possibility of depression."
Experts say depressed cardiac patients have at least twice the risk of second events in the one to two years after a heart attack. Furthermore, studies have shown that more severe depression is associated with earlier and more severe second cardiac events, Froelicher said.
"Studies show that depression is about three times more common in patients following a heart attack than in the general community," said Judith H. Lichtman, Ph.D., M.P.H., writing co-chair of the statement and associate professor of epidemiology at Yale University School of Medicine in New Haven, CT. "Because there has been no routine screening for depression in heart patients, we think there is a large group of people who could benefit from appropriate treatment."
Other recommendations in the statement include:
- Patients who have depressive symptoms should be evaluated by a professional qualified in diagnosing and managing depression, and should be screened for other psychiatric disorders, such as anxiety.
- Treatment options include cognitive behavioral therapy, physical activity, cardiac rehabilitation, antidepressant drugs or combinations of those treatments.
- Selective serotonin reuptake inhibitor (SSRI) treatment soon after a heart attack is considered safe, relatively inexpensive and may be effective for treating depression.
- Routine screening for depression in coronary heart disease patients should be done in multiple settings, including the hospital,physician's office, clinic and cardiac rehabilitation center, to avoid missing the opportunity to effectively treat depression in cardiac patients and improve physical health outcomes.
- Coordination of care between health providers is essential for patients with combined medical and psychiatric diagnoses.

"Depression and heart disease seem to be very much intertwined," Lichtman said. "You can't treat the heart in isolation from the patient's mental health. There is no direct evidence yet that treating depression improves coronary heart disease outcomes, but plenty of evidence shows that having depression worsens those outcomes. By understanding the prevalence of depression and learning more about the subgroups of heart patients at particular risk of depression, we can begin to understand the best ways to recognize and treat it."
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