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Screening, referral and treatment for depression in patients with coronary heart disease

David M Colquhoun, Stephen J Bunker, David M Clarke, Nick Glozier, David L Hare, Ian B Hickie, James Tatoulis, David R Thompson, Geoffrey H Tofler, Alison Wilson and Maree G Branagan
Med J Aust 2013; 198 (9): 483-484. || doi: 10.5694/mja13.10153

Summary

  • In 2003, the National Heart Foundation of Australia position statement on “stress” and heart disease found that depression was an important risk factor for coronary heart disease (CHD). This 2013 statement updates the evidence on depression (mild, moderate and severe) in patients with CHD, and provides guidance for health professionals on screening and treatment for depression in patients with CHD.

  • The prevalence of depression is high in patients with CHD and it has a significant impact on the patient’s quality of life and adherence to therapy, and an independent effect on prognosis. Rates of major depressive disorder of around 15% have been reported in patients after myocardial infarction or coronary artery bypass grafting.

  • To provide the best possible care, it is important to recognise depression in patients with CHD. Routine screening for depression in all patients with CHD is indicated at first presentation, and again at the next follow-up appointment. A follow-up screen should occur 2–3 months after a CHD event. Screening should then be considered on a yearly basis, as for any other major risk factor for CHD.

  • A simple tool for initial screening, such as the Patient Health Questionnaire-2 (PHQ-2) or the short-form Cardiac Depression Scale (CDS), can be incorporated into usual clinical practice with minimum interference, and may increase uptake of screening.

  • Patients with positive screening results may need further evaluation. Appropriate treatment should be commenced, and the patient monitored. If screening is followed by comprehensive care, depression outcomes are likely to be improved.

  • Patients with CHD and depression respond to cognitive behaviour therapy, collaborative care, exercise and some drug therapies in a similar way to the general population. However, tricyclic antidepressant drugs may worsen CHD outcomes and should be avoided.

  • Coordination of care between health care providers is essential for optimal outcomes for patients. The benefits of treating depression include improved quality of life, improved adherence to other therapies and, potentially, improved CHD outcomes.

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  • David M Colquhoun1
  • Stephen J Bunker2
  • David M Clarke3
  • Nick Glozier4
  • David L Hare5
  • Ian B Hickie4
  • James Tatoulis6
  • David R Thompson7
  • Geoffrey H Tofler8
  • Alison Wilson6
  • Maree G Branagan6

  • 1 University of Queensland, Brisbane, QLD.
  • 2 Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, VIC.
  • 3 School of Psychology and Psychiatry, Monash University, Melbourne, VIC.
  • 4 Brain and Mind Research Institute, University of Sydney, Sydney, NSW.
  • 5 Austin Hospital, Melbourne, VIC.
  • 6 National Heart Foundation of Australia, Melbourne, VIC.
  • 7 Cardiovascular Research Centre, Australian Catholic University, Melbourne, VIC.
  • 8 Cardiology Department, Royal North Shore Hospital, University of Sydney, Sydney, NSW.


Acknowledgements: 

We thank Brian Oldenburg, Adrienne O’Neil, Michael Jelinek and Alex Brown for their consultation and contribution to the content of this document.

Competing interests:

David Colquhoun has been a member of advisory groups for industry including for MSD, Pfizer (Lipid advisory group), Abbott (Fish oil advisory group). He has undertaken research for Boehringer Ingelheim (RELY trial), Abbott (SCOUT trial), BMS (SAVOR trial), and for Sanofi-Aventis (PALLAS Trial and ORIGIN Trial). He is also a member of the Gallipoli Research Foundation Scientific Committee. David Hare developed the CDS, and has received research, fellowship and consultancy funds from the NHMRC, the NHFA, the Austin Medical Research Foundation, beyondblue, and Diabetes Australia. He has received payment for research projects, consultancies, travel, advisory board memberships and lectures from industry including Abbott, Amgen, AstraZeneca, Biotronic, BMS, Boehringer Ingelheim, CSL-Biotherapies, Hoffmann-LaRoche, Hospira, Lundbeck (Denmark), Medtronic, Menarini, Merck KA (Germany), Merck (US), MSD, Pfizer, Roche, Sanofi-Aventis, Servier and Wyeth. Ian Hickie was supported by an NHMRC Australia Fellowship (464914). He was a director of headspace: the national youth mental health foundation until January 2012. He is the executive director of the Brain and Mind Research Institute, which operates two early intervention youth services under contract to headspace. He is a member of the new Australian National Mental Health Commission and was previously the CEO of beyondblue. He has led a range of community-based and pharmaceutical industry-supported depression awareness and education and training programs, and depression and other mental health research projects supported by a variety of pharmaceutical partners. His current investigator-initiated studies are supported by Servier and Pfizer. He has received honoraria for his contributions to professional educational seminars supported by the pharmaceutical industry (including Servier, Pfizer, AstraZeneca, Janssen and Eli Lilly). Nick Glozier has been funded under a strategic research grant program by beyondblue and the NHFA. He has received other depression-related research funds from the NHMRC, beyondblue, the Australian Research Council and Servier Laboratories. He has received travel and consultancy fees from Servier Laboratories. There are no relevant disclosures for the other authors.

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