Depression screening may not improve quality of life in heart attack survivors: JAMA

USA: Contrary to recommendations from professional societies, a recent study has found that depression screening and treatment in heart attack survivors provided no additional benefit than usual care.

The study, published in the JAMA Internal Medicine journal showed that systematic depression screening did not alter the quality of life, depression-free days, or harms in ACS (acute coronary syndrome) patients without a history of depression.

According to Mayo Clinic, ACS is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart. One such condition is a heart attack (myocardial infarction) — when cell death results in damaged or destroyed heart tissue.

"Patients with ACS and elevated depressive symptoms are at increased risk of worse quality of life, recurrent cardiovascular events and mortality, and higher health care costs. These observational findings prompted multiple scientific panels to recommend universal depression screening in ACS survivors prior to evidence from randomized screening trials," wrote the authors.

Ian M. Kronish, Columbia University Irving Medical Center, New York, New York, and colleagues conducted the study to determine whether systematically screening for depression in survivors of ACS improves quality of life and depression compared with usual care.

A total of 1500 patients (424 women and 1076 men; mean [SD] age, 65.9 [11.5] years) were included in the 18-month trial. They were randomly assigned 1:1:1 to receive:

1. systematic depression screening using the 8-item Patient Health Questionnaire, with notification of primary care clinicians and provision of centralized, patient-preference, stepped depression care for those with positive screening results (8-item Patient Health Questionnaire score ≥10; screen, notify, and treat, n = 499);


2. systematic depression screening, with notification of primary care clinicians for those with positive screening results (screen and notify, n = 501); and


3. usual care (no screening, n = 500).

The primary outcome was a change in quality-adjusted life-years. The secondary outcome was depression-free days. Adverse effects and mortality were assessed by patient interview and hospital records.

Key findings include:

• Only 71 of 1000 eligible survivors of ACS (7.1%) had elevated 8-item Patient Health Questionnaire scores indicating depressive symptoms at screening.


• There were no differences in mean (SD) change in quality-adjusted life-years (screen, notify and treat, –0.06 [0.20]; screen and notify, −0.06 [0.20]; no screen, −0.06 [0.18]; P = .98) or cumulative mean (SD) depression-free days (screen, notify and treat, 343.1 [179.0] days; screen and notify, 351.3 [175.0] days; no screen, 339.0 [176.6] days; P = .63).


• Harms including death, bleeding, or sleep difficulties did not differ among groups.

"Despite the risk associated with depression, our data suggest that a strategy of systematically screening patients with ACS for depression is unlikely to lead to substantial population-level benefits in terms of improved quality of life or depression-free days," the researchers concluded.

"Future studies could investigate if motivation, interest, adherence, and/or engagement differ between patients with depression detected by screening and patients with depression who are seeking treatment," the group suggested.

More Information: "Effect of Depression Screening After Acute Coronary Syndromes on Quality of LifeThe CODIACS-QoL Randomized Clinical Trial" published in the JAMA Internal Medicine journal.

DOI: 10.1001/jamainternmed.2019.4518

Journal Information: JAMA Internal Medicine