Top Things to Know: Depression as a Risk Factor for Poor Prognosis Among Patients With Acute Coronary Syndrome: Systematic Review and Recommendations
Published: February 24, 2014
- Depression and elevated depressive symptoms are common among the estimated 15.4 million US adults with coronary heart disease (CHD).
- Numerous prospective studies, systematic reviews, and meta-analyses have shown a robust association between depression (major depression or elevated depressive symptoms) and increased morbidity and mortality after acute coronary syndrome (ACS).
- The committee conducted an extensive review of published studies to make a recommendation as to whether depression should be elevated by the AHA to the status of a risk factor for ACS.
- To formulate recommendations, strength, consistency, independence, and generalizability of the findings were evaluated in a set of carefully selected studies.
- The 3 outcomes of interest were as follows:
- all-cause mortality,
- cardiac mortality, and
- composite outcomes that included mortality and nonfatal events.
- Inclusion criteria for studies of patients recovering from ACS were
- prospective design,
- included ≥100 patients,
- used established assessment instruments to define major depression or depressive symptoms, and
- reported all-cause mortality, cardiac mortality, or a combination of either of these mortality outcomes and nonfatal events.
- A total of 53 individual studies were evaluated (32 reported on associations with all-cause mortality, 12 on cardiac mortality, and 22 on composite outcomes) and 4 meta-analyses met inclusion criteria.
- The review identified heterogeneity in the published findings from these studies in terms of the demographic composition of the samples, the definition and measurement of depression, the length of follow-up, and the covariates included in the multivariable statistical models.
- The committee identified a number of ways in which the evidence linking depression with ACS, or CHD in general, could be strengthened in terms of the study design, presentation of results, and future directions for research.
- The preponderance of evidence supports the conclusion that depression after ACS is a risk factor for all-cause and cardiac mortality, as well as for composite outcomes including mortality or nonfatal cardiac events.
Citation
Lichtman JH, Froelicher ES, Blumenthal JA, Carney RM, Doering LV, Frasure-Smith N, Freedland KE, Jaffe AS, Leifheit-Limson EC, Sheps DS, Vaccarino V, Wulsin L; on behalf of the American Heart Association Statistics Committee of the Council on Epidemiology and Prevention and the Council on Cardiovascular and Stroke Nursing. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation. doi: 10.1161/CIR.0000000000000019.
http://circ.ahajournals.org/lookup/doi/10.1161/CIR.0000000000000019.