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Depression screening in patients with coronary heart disease: a critical evaluation of the AHA guidelines.
J Psychosom Res 2011; 71(1):6-12JP

Abstract

OBJECTIVE

We lack evidence that routine screening for depression in patients with coronary heart disease (CHD) improves patient outcome. This lack has challenged the advisory issued by the American Heart Association (AHA) to routinely screen for depression in CHD patients. We assess the AHA advisory in the context of well-established criteria of screening for diseases.

METHODS

Using principles and criteria for screening developed by the World Health Organization and the United Kingdom National Screening Committee, we generated criteria pertinent to screening for depression in CHD patients. To find publications relevant to these criteria and clinical setting, we performed a broadly based literature search on "depression and CHD," supplemented by more focused literature searches.

RESULTS

Evidence for an association between depression and CHD is strong. Despite this, the AHA advisory has several limitations. It did not account for the complexity of the association between depression and CHD. It acknowledged there was no evidence that screening for depression leads to improved outcomes in cardiovascular populations but still recommended routine screening without providing an alternative evidence-based explanation. It ignored the paucity of literature about the safety and cost-effectiveness of routine screening for depression in CHD and failed to define the nature and extent of resources needed to implement such a program effectively.

CONCLUSION

We conclude that the AHA advisory is premature. We must first demonstrate the efficacy, safety, and cost-effectiveness of screening and define the resources necessary for its implementation and monitoring. Meanwhile, organizations representing cardiologists, psychiatrists, and general practitioners must coordinate efforts to manage depression and CHD through collaborative care, and work with the policy makers to develop the necessary infrastructure and services delivery system needed to optimize the outcome of depressed and at-risk-for-depression patients suffering from CHD.

Authors+Show Affiliations

Department of Psychiatry, Memorial University of Newfoundland, St. John's, Newfoundland, Canada. mehrul_hasnain@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Review

Language

eng

PubMed ID

21665006

Citation

Hasnain, Mehrul, et al. "Depression Screening in Patients With Coronary Heart Disease: a Critical Evaluation of the AHA Guidelines." Journal of Psychosomatic Research, vol. 71, no. 1, 2011, pp. 6-12.
Hasnain M, Vieweg WV, Lesnefsky EJ, et al. Depression screening in patients with coronary heart disease: a critical evaluation of the AHA guidelines. J Psychosom Res. 2011;71(1):6-12.
Hasnain, M., Vieweg, W. V., Lesnefsky, E. J., & Pandurangi, A. K. (2011). Depression screening in patients with coronary heart disease: a critical evaluation of the AHA guidelines. Journal of Psychosomatic Research, 71(1), pp. 6-12. doi:10.1016/j.jpsychores.2010.10.009.
Hasnain M, et al. Depression Screening in Patients With Coronary Heart Disease: a Critical Evaluation of the AHA Guidelines. J Psychosom Res. 2011;71(1):6-12. PubMed PMID: 21665006.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Depression screening in patients with coronary heart disease: a critical evaluation of the AHA guidelines. AU - Hasnain,Mehrul, AU - Vieweg,W Victor R, AU - Lesnefsky,Edward J, AU - Pandurangi,Ananda K, Y1 - 2010/12/16/ PY - 2010/02/06/received PY - 2010/10/21/revised PY - 2010/10/21/accepted PY - 2011/6/14/entrez PY - 2011/6/15/pubmed PY - 2011/11/1/medline SP - 6 EP - 12 JF - Journal of psychosomatic research JO - J Psychosom Res VL - 71 IS - 1 N2 - OBJECTIVE: We lack evidence that routine screening for depression in patients with coronary heart disease (CHD) improves patient outcome. This lack has challenged the advisory issued by the American Heart Association (AHA) to routinely screen for depression in CHD patients. We assess the AHA advisory in the context of well-established criteria of screening for diseases. METHODS: Using principles and criteria for screening developed by the World Health Organization and the United Kingdom National Screening Committee, we generated criteria pertinent to screening for depression in CHD patients. To find publications relevant to these criteria and clinical setting, we performed a broadly based literature search on "depression and CHD," supplemented by more focused literature searches. RESULTS: Evidence for an association between depression and CHD is strong. Despite this, the AHA advisory has several limitations. It did not account for the complexity of the association between depression and CHD. It acknowledged there was no evidence that screening for depression leads to improved outcomes in cardiovascular populations but still recommended routine screening without providing an alternative evidence-based explanation. It ignored the paucity of literature about the safety and cost-effectiveness of routine screening for depression in CHD and failed to define the nature and extent of resources needed to implement such a program effectively. CONCLUSION: We conclude that the AHA advisory is premature. We must first demonstrate the efficacy, safety, and cost-effectiveness of screening and define the resources necessary for its implementation and monitoring. Meanwhile, organizations representing cardiologists, psychiatrists, and general practitioners must coordinate efforts to manage depression and CHD through collaborative care, and work with the policy makers to develop the necessary infrastructure and services delivery system needed to optimize the outcome of depressed and at-risk-for-depression patients suffering from CHD. SN - 1879-1360 UR - https://www.unboundmedicine.com/medline/citation/21665006/Depression_screening_in_patients_with_coronary_heart_disease:_a_critical_evaluation_of_the_AHA_guidelines_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3999(10)00413-7 DB - PRIME DP - Unbound Medicine ER -