AHA Recommends Routine Depression Screening for Patients With Heart Disease

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Title: AHA Recommends Routine Depression Screening for Patients With Heart Disease
URL: http://www.pslgroup.com/dg/22DE8A.htm
Doctor's Guide
September 30, 2008

DALLAS -- September 30, 2008 -- The American Heart Association (AHA) recommends that patients with heart disease be screened routinely for depression. The AHA's first scientific statement on depression and coronary heart disease was published in Circulation: Journal of the American Heart Association.

"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, PhD, University of California San Francisco, School of Nursing and Medicine, San Francisco, California.

Although depression was mentioned in earlier American Heart Association scientific statements, this is the first to specifically target the condition.

"Studies show that depression is about 3 times more common in patients following a heart attack than in the general community," said Judith H. Lichtman, PhD, Yale University School of Medicine, New Haven, Connecticut. "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."

Recent studies indicate that depressed patients are less likely to take their medicines as directed, improve their diets, exercise, and attend cardiac rehabilitation sessions, all of which could contribute to a worse outcome, Lichtman said.

It's also possible that biological changes associated with depression such as reduced heart rate variability and increases in blood factors that encourage clot formation could increase risk, the statement said.

The recommendations, which are endorsed by the American Psychiatric Association, include the following:

· Early and repeated screening for depression in heart patients

· The use of 2 questions to screen patients, with the remaining 7 questions to be asked if depression is suspected

· Coordinated follow-up for both heart disease and depressive symptoms in patients who have both

· 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 behavioural 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 centre, 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.

The entire statement can be viewed here:

http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.108.190769

SOURCE: American Heart Association

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