Long-term cardiac outcomes of depression screening, diagnosis and treatment in patients with acute coronary syndrome: the DEPACS study. Issue 6 (7th April 2021)

• Record Type: Journal Article
• Authors: Kim, Jae-Min; Stewart, Robert; Kang, Hee-Ju; Kim, Seon-Young; Kim, Ju-Wan; Lee, Hee-Joon; Lee, Ju-Yeon; Kim, Sung-Wan; Shin, Il-Seon; Kim, Min-Chul; Shin, Hee-Young; Hong, Young Joon; Ahn, Youngkeun; Jeong, Myung Ho; Yoon, Jin-Sang
• Is Part Of: Psychological medicine. Volume 51:Issue 6(2021)
• Page Start: 964
• Page End: 974
• Publication Date: 2021-04-07
• Subjects: Acute coronary syndrome, -- cardiac outcome, -- depression, -- screening, -- treatment; Psychiatry -- Periodicals; Medicine and psychology -- Periodicals; Clinical psychology -- Periodicals; 616.89
• DOI: 10.1017/S003329171900388X
• Languages: English
• ISSNs: 0033-2917

Abstract

Abstract: Background: To investigate the impacts of depression screening, diagnosis and treatment on major adverse cardiac events (MACEs) in acute coronary syndrome (ACS). Methods: Prospective cohort study including a nested 24-week randomised clinical trial for treating depression was performed with 5–12 years after the index ACS. A total of 1152 patients recently hospitalised with ACS were recruited from 2006 to 2012, and were divided by depression screening and diagnosis at baseline and 24-week treatment allocation into five groups: 651 screening negative (N), 55 screening positive but no depressive disorder (S), 149 depressive disorder randomised to escitalopram (E), 151 depressive disorder randomised to placebo (P) and 146 depressive disorder receiving medical treatment only (M). Results: Cumulative MACE incidences over a median 8.4-year follow-up period were 29.6% in N, 43.6% in S, 40.9% in E, 53.6% in P and 59.6% in M. Compared to N, screening positive was associated with higher incidence of MACE [adjusted hazards ratio 2.15 (95% confidence interval 1.63–2.83)]. No differences were found between screening positive with and without a formal depressive disorder diagnosis. Of those screening positive, E was associated with a lower incidence of MACE than P and M. M had the worst outcomes even compared to P, despite significantly milder depressive symptoms at baseline. Conclusions: Routine depression screening in patients with recent ACS and subsequent appropriate treatment of depression could improve long-term cardiac outcomes.