Key result
Briefly-assessed baseline depression in patients with acute coronary syndrome significantly predicted continuation of smoking at one year (OR 2.3), as well as failure to return to work and increased healthcare utilization.
Why the study?
Does baseline depression predict poorer secondary prevention outcomes at one year in patients with acute coronary syndrome?
Cohort (n=681)
Yes
Does baseline depression predict poorer secondary prevention outcomes at one year in patients with acute coronary syndrome?
Effect estimate: OR 2.3 (95% CI 1.3-4.0)
p-value: p=0.003
Brief depression assessment during ACS hospitalization identifies patients at higher risk for poor secondary prevention outcomes, including continued smoking and failure to return to work at one year.
Supports brief depression screening in ACS to flag high-risk patients; hypothesis-generating for targeted interventions.
BACKGROUND: Patients with acute coronary syndromes (ACS) are at increased risk of further acute cardiac events. Secondary prevention aims to decrease morbidity and mortality post-ACS. Depression is related to increased risk in this population, and to poorer secondary prevention activities. However, lengthy depression assessment techniques preclude depression assessment in routine care. The present study investigated the relationship of briefly-assessed depression with secondary prevention outcomes one year post-ACS. METHODS: Following ethics committee approval, hospitals recruited patients for a national survey of ACS. Consenting patients with ACS completed a brief depression scale during hospitalisation. The predictive validity of two brief scales was independently assessed, with groups combined for the overall sample. Participants then completed a one-year longitudinal follow-up postal survey of secondary prevention activities. RESULTS: The response rate for follow-up was 86% (n = 681). Proportions taking anti-platelet (88% v 87%; p = 0.334) and lipid-lowering (83% v 84%; p = 0.437) therapies remained unchanged. Prevalence of smoking (40% v 22%; p < 0.001), and median number of cigarettes smoked (20 v 10; p < 0.001) were significantly reduced at one year. Fifty-six per cent of patients reported attending cardiac rehabilitation programmes. Of those aged < 65 years at baseline, 54% had returned to work at one year. A majority (56%) reported feeling physically better. Prevalence of depression was unchanged in those who completed a depression scale at both time points (15% v 17%; p = 0.434). Baseline depression did not predict taking anti-platelet, blood pressure or cholesterol medications (all p > 0.05), but did predict continuation of smoking (OR = 2.3, 95% CI 1.3-4.0, p = 0.003), a higher (above median) number of general practitioner visits (OR = 2.1, 95% CI 1.3-3.4, p = 0.005), failure to return to work (OR = 0.4, 95% CI 0.2-0.8, p = 0.015), and not feeling better (OR = 0.6, 95% CI 0.3-1.0, p = 0.05) at one year. CONCLUSION: Rapid depression assessment can be used to help identify patients with ACS at risk of a range of poorer secondary prevention outcomes. The results provide support for the routine screening of depression in acute settings. Strategies to increase rates of smoking cessation, return to work, general well-being and decrease health service use by depressed patients may need to incorporate some element of treatment for depression.
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McGee et al. (2006) conducted a cohort in Acute coronary syndrome (ACS) (n=681). Briefly-assessed depression vs. No depression was evaluated on Continuation of smoking at one year (OR 2.3, 95% CI 1.3-4.0, p=0.003). Briefly-assessed baseline depression in patients with acute coronary syndrome significantly predicted continuation of smoking at one year (OR 2.3), as well as failure to return to work and increased healthcare utilization.
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