Depression is Widespread Among Heart Attack Patients

One in five patients hospitalized for heart attack suffers from major depression, and these patients may be more likely
than other heart attack patients to need hospital care again within a year for a cardiac problem and three times as likely to
die from a future attack or other heart problems, according to a new evidence report by HHS' Agency for Healthcare Research
and Quality.


The scientific evidence review on which the report is based suggests that 60 percent to 70 percent of individuals who become
depressed when hospitalized for heart attack continue to suffer from depression for 1 month to 4 months or more after
discharge. Major depression lasts 2 weeks or longer and is accompanied by five or more symptoms-including feelings of
sadness, hopelessness, pessimism and a general loss of interest in life-that hinder a person's ability to carry out normal,
everyday activities.


The reviewers also found that, during the first year following a heart attack, those with major depression can have a
delay in returning to work, worse quality of life, and worse physical and psychological health. In fact, some studies show
that depression that begins while the patient is hospitalized can continue to affect his or her psychological and physical
health for as long as 5 years after discharge. Approximately 765,000 Americans were discharged following treatment for heart
attacks in 2002, according to national hospital data from AHRQ.


"This report provides the scientific evidence clinicians need to know about the prevalence of depression in heart
attack survivors, how depression affects these patients, and the need to treat the disease early," said AHRQ Director Carolyn
M. Clancy, M.D.


The American Academy of Family Physicians, which requested the evidence review, plans to use the report to develop
evidence-based clinical practice guidelines.


The reviewers found strong evidence that both counseling and certain antidepressants, such as selective serotonin
reuptake inhibitors, are effective at reducing symptoms of depression in patients following a heart attack, but there is no
evidence that either therapy reduces the likelihood of suffering future cardiac events or the odds of dying from them.



Reviewers of the AHRQ-supported Johns Hopkins University Evidence-Based Practice Center in Baltimore, led by David E. Bush,
M.D., and Roy C. Ziegelstein, M.D., could not conclude whether the frequency of needing prescription medicines for cardiac
problems or cardiac procedures is influenced by depression. However, they did find relatively strong evidence that patients
with post-heart attack depression are less likely than other heart attack survivors to take their medications as instructed
or to follow doctors' advice for helping to prevent future heart attacks by losing weight, reducing salt consumption or
exercising, for example.















The reviewers found insufficient evidence to adequately assess the performance of methods used to screen patients for
depression while patients are hospitalized for heart attack. However, the review also found that most of the commonly used
screening instruments and rating scales are accurate enough to identify depression when used within 3 months after the
patient's initial hospitalization for heart attack.


The reviewers called for additional research to expand the evidence base, including studies to determine the major causes of
death among depressed post-heart attack patients, whether treatment improves their outcomes relative to similar patients not
suffering from depression and the definition of the most clinically relevant measure of depression during initial heart
attack hospitalization.


Details are in Evidence Report on Post-Myocardial Infarction Depression. The summary is on AHRQ's Web site at ahrq/clinic/epcsums/midepsum.htm, and the full
report is available at ahrq/downloads/pub/evidence/pdf/postmidep/midep.pdf. Printed copies are available by calling AHRQ's
Publications Clearinghouse at (800) 358-9295 or sending an e-mail to ahrqpubsahrq.


AHRQ conducts and sponsors a wide range of studies designed to find the best scientific evidence for what works and what
doesn't. This research was conducted by one of AHRQ's 13 Evidence-based Practice Centers, which review all relevant
scientific literature on clinical, behavioral, and organization and financing topics to produce evidence reports and
technology assessments. These reports are used for informing and developing coverage decisions, quality measures, educational
materials and tools, guidelines and research agendas.