[ad_1]
After suffering a heart attack or unstable angina (chest pain caused by blockage of arteries), patients routinely screened for depression and referred for treatment, if any, did not show any significant improvement quality of life compared to those not benefiting from any screening for depression. at research presented at the American College of Cardiology & # 39; s 68th Annual scientific session.
Experts have identified depression as a risk factor for heart disease. Previous studies have estimated that at least one in five patients with acute coronary syndrome also had symptoms of depression. In addition, there is evidence that depression following a cardiac event can significantly increase the risk of subsequent heart problems and death for whatever reason. The new study suggests using currently available questionnaires to screen for depression after an unstable heart attack or angina in patients, this is not an effective way of reducing depression that is affecting quality of life patients. However, the results suggest that other ways to fight depression may be more effective, according to the researchers.
"Based on this study and the best evidence we have, we see no justification for devoting large resources to systematic and systematic screening for depression in these patients," said Ian Matthew Kronish, MD, badociate professor of medicine. at Columbia University Medical Center and the main author of the study. "However, that does not mean that doctors should not be on the lookout for signs of depression, or that, if they notice it, they should ignore it." Depression still has an impact the quality of life and the prognosis of the patients, and if the doctors discover it, they must absolutely try to treat it with treatments which can reduce the depressive symptoms. "
The researchers recruited just over 1,500 inpatients in the previous two to 12 months for acute coronary syndrome, a group of conditions including heart attacks and unstable angina, in four US medical centers. The patients were randomly divided into three groups. The first group received no screening for depression. The remaining patients were asked to complete the eight-question Patient Health Questionnaire designed to identify depression. For half of these patients, a positive screening resulted in a notification of both the patient and his primary health care provider, as well as an invitation to participate in depression care. For the other half, positive screening only led to the notification of the patient and their primary health care provider, leaving them to determine the next steps in the treatment of depression.
Overall, the study identified depression in approximately 7% of screened patients. This figure is slightly lower than in previous studies where major depression affected approximately 10% of patients with acute coronary syndrome. This is due in part to the fact that people already treated for depression and those with a history of depression were excluded from the study, Kronish said. In addition, depressive symptoms were badessed at least two months after acute coronary syndrome; Depressive symptoms that are elevated immediately after acute coronary syndromes often go away without treatment of depression.
Researchers followed participants for 18 months and badessed changes in their quality of life based on the number of quality-adjusted life years (QALYs), the primary endpoint of the study. 39; test. QALYs indicate how much a person with a physical or mental disability has a negative impact on a person's life, with a point representing a perfect health year and zero point representing death. No significant difference was found between the three study groups, with these three groups recording a very small drop in the number of AVAQs (mean decrease from 0.03 to 0.04 point) on 18 months.
In addition, no significant difference was observed between groups in terms of cumulative number of days without depression among participants, which ranged from 339 to 351 for the 18-month period. There was also no significant difference in terms of depressive symptoms at nine months, reported side effects of antidepressants, or death rates or hemorrhages.
Among the group of patients who benefited from the most extensive intervention – notification of positive screening and invitation to participate in depression care offered for free – about a quarter of patients refused treatment for depression provided by the study providers. Those who accepted the invitation received medication, telephone psychotherapy sessions or a combination of both, depending on the patient's preferences – a therapeutic approach that has proven effective in others. trials. Although the trial showed no significant benefit in this screening approach for these patients compared to other groups, Kronish said further study was needed to identify effective ways to combat depression and its badociated risks in people with acute coronary syndrome.
"We hope that this is not the last word on this issue and that others will look for different ways to identify survivors of a heart attack who could benefit from". a treatment against depression, "said Kronish. "In addition, we need to think about how we can improve our treatments for depression to achieve greater benefit, which could make testing more cost-effective."
In addition to exploring different approaches to screening for and treating depression, Kronish added that it may be helpful to better inform patients about the impact of depressive symptoms on heart health, which could improve patient engagement. to their care and increase the effectiveness of the treatment of depression.
[ad_2]
Source link
