Enhanced treatment for patients with persistent depressive symptoms after ACS

January 01, 0001

Enhanced treatment for patients with persistent depressive symptoms after ACS

Depressive symptoms are an established predictor of mortality and major adverse cardiac events (defined as nonfatal myocardial infarction or hospitalization for unstable angina or urgent/emergency revascularizations) in patients with acute coronary syndrome (ACS). This study was conducted to determine the acceptability and efficacy of enhanced depression treatment in patients with ACS. These US authors conducted a 3-month observation period to identify patients with ACS and persistent depressive symptoms followed by a 6- month randomized controlled trial including 237 patients of which 157 were persistently depressed. Patients were randomized to intervention (initial patient preference for problem-solving therapy and/or pharmacotherapy, then a stepped-care approach; 80 patients) or usual care (77 patients). The 80 nondepressed patients underwent observational evaluation.

They found: "At the end of the trial, the proportion of patients who were satisfied with their depression care was higher in the intervention group (54% of 80) than in the usual care group (19% of 77) (odds ratio 5.4). The Beck Depression Inventory score decreased significantly more (t155 = 2.85) for intervention patients (change, -5.7) than for usual care patients (change, -1.9); the depression effect size was 0.59 of the standard deviation. At the end of the trial, 3 intervention patients and 10 usual care patients had experienced major adverse cardiac events (4% and 13%, respectively, significant), as well as 5 nondepressed patients (6%)."

The authors concluded: "Enhanced depression care for patients with ACS was associated with greater satisfaction, a greater reduction in depressive symptoms, and a promising improvement in prognosis."

The NNT was 11 to prevent one major adverse cardiac event, which suggests that the authors approach is worthwhile, possibly even cost saving.

For the full abstract, click here.

Arch Intern Med 170(7):600-608, 12 April 2010 © 2010 to the American Medical Association
Enhanced Depression Care for Patients With Acute Coronary Syndrome and Persistent Depressive Symptoms-Coronary Psychosocial Evaluation Studies Randomized Controlled Trial. Karina W. Davidson, Nina Rieckmann, Lynn Clemow, et al. Correspondence to Dr. Davidson: [email protected]

Category: P. Psychological, K. Circulatory. Keywords: depression, acute coronary syndrome, problem-solving therapy, pharmacotherapy, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 23 April 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.