Screening for Depression in Cardiac Rehabilitation

Cahill, Megan C.; Bilanovic, Ana; Kelly, Shannon; Bacon, Simon; Grace, Sherry L.

doi:10.1097/hcr.0000000000000101

Cited by 22 publications

(20 citation statements)

References 40 publications

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“…While the results of this secondary analysis cannot be considered conclusive evidence, findings would suggest that screening recall was not related to lower depressive symptoms among female cardiac patients 6 months later. Thus, these findings suggest research is needed on actual screening in the CR setting and the effects on downstream symptoms and health outcomes [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Burden, screening, and treatment of depressive and anxious symptoms among women referred to cardiac rehabilitation: a prospective study

et al. 2017

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BackgroundCardiovascular disease (CVD) is one of the leading causes of morbidity and mortality among women. Women with CVD experience a greater burden of psychosocial distress than men, and practice guidelines promote screening in cardiac patients, especially women. The objectives herein were to describe the burden of psychosocial distress, extent of screening, forms of treatment, and whether receipt of treatment was related to psychosocial distress symptom severity at follow-up, among women.MethodsWithin a multi-center trial of women randomized to cardiac rehabilitation models, consenting participants were asked to complete surveys upon consent and 6 months later. Clinical data were extracted from charts. This study presents a secondary analysis of the surveys, including investigator-generated items assessing screening and treatment, the Beck Depression Inventory-II, the Hospital Anxiety and Depression Scale, and Patient Health Questionnaire-2.ResultsOf the 128 (67.0%) participants with valid baseline and follow-up survey results, 48 (40.3%) self-reported that they recalled being screened, and of these, 10 (21.3%) recalled discussing the results with a health care professional. Fifty-six (43.8%) retained participants had elevated symptoms of psychosocial distress at baseline, of which 25 (44.6%) were receiving treatment. Regression analyses showed that treatment of psychosocial distress was not significantly associated with follow-up depressive symptoms, but was significantly associated with greater follow-up anxiety.ConclusionsFindings reiterate the great burden of psychosocial distress among women with CVD. Less than half of patients with elevated symptoms were treated, and the treatment approaches appeared to insufficiently achieve symptom relief.

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Section: Discussionmentioning

confidence: 99%

Burden, screening, and treatment of depressive and anxious symptoms among women referred to cardiac rehabilitation: a prospective study

et al. 2017

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“…American Heart Association guidelines have recommended depression screening in all cardiac patients since 2008, and evidence suggests that targeted treatment can improve depressive symptoms and may be linked to reductions in cardiac mortality . All the same, there is substantial evidence that implementation of this guideline is inconsistent, nor does it address other types of mental illness.…”

Section: Discussionmentioning

confidence: 99%

Mental illness and obesity among Veterans undergoing percutaneous coronary intervention: Insights from the VA CART program

et al. 2019

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Mental illness and obesity are highly prevalent in patients with coronary disease and are frequently comorbid. While mental illness is an established risk factor for major adverse cardiac and cerebrovascular events (MACCEs), prior studies suggest improved outcomes in people with obesity. It is unknown if obesity and mental illness interact to affect cardiac outcomes or if they independently influence MACCE. We identified 55 091 patients undergoing percutaneous coronary intervention (PCI) between 2009 and 2014, using the Veterans Affairs (VA) Clinical Assessment Reporting and Tracking (CART) program. Cox methods were used to assess the risk of MACCE by weight status and psychiatric diagnosis, and assessed for interaction. Compared to normal weight status, higher weight was associated with reduced MACCE events after PCI (mean follow‐up of 2 years) for both stable angina and acute coronary syndromes (ACSs; reduction of >13% in stable angina, >17% in ACS; P < 0.01 for both after adjustment). Having a non‐substance abuse mental illness diagnosis increased risk of MACCE compared to patients without mental illness in stable angina over 17%; P < 0.05, but not in ACS. When analysed for interaction, obesity and mental illness did not significantly impact MACCE over their independent influences. These results suggest that mental illness along with weight status have significant impact on MACCE, post‐PCI. Clinicians should be aware of patients' mental health status as a significant cardiovascular risk factor after PCI, independent of weight status.

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“…The British National Institute for Health and Care Excellence (NICE) recommends case identification and recognition in patients with chronic physical health problems [ 8 ], whereas the American Heart Association (AHA) specifically recommends depression screening for all patients suffering from chronic heart disease (CHD) [ 9 ]. However, there are no randomized controlled trials assessing the efficacy of depression screening in patients with heart diseases [ 10 , 11 ]. Evidence was exclusively derived from observational studies, e.g.…”

Section: Introductionmentioning

confidence: 99%

“…Evidence was exclusively derived from observational studies, e.g. Burton et al, reporting a small increase in the number of new diagnoses and treatments [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Depression screening with patient-targeted feedback in cardiology: The cost-effectiveness of DEPSCREEN-INFO

et al. 2017

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BackgroundAlthough depression is common in patients with heart disease, screening for depression is much debated. DEPSCREEN-INFO showed that a patient-targeted feedback in addition to screening results in lower depression level six months after screening. The purpose of this analysis was to perform a cost-effectiveness analysis of DEPSCREEN-INFO.MethodsPatients with coronary heart disease or arterial hypertension were included. Participants in both groups were screened for depression. Participants in the intervention group additionally received a patient-targeted feedback of their result and recommended treatment options. A cost-utility analysis using quality-adjusted life years (QALY) based on the EQ-5D was performed. The time horizon was 6 months. Resource utilization was assessed by a telephone interview. Multiple imputation using chained equations was used. Net-benefit regressions controlled for prognostic variables at baseline were performed to construct cost-effectiveness acceptability curves. Different sensitivity analyses were performed.Results375 participants (intervention group: 155; control group: 220) were included at baseline. After 6 months, in the intervention group adjusted total costs were lower (-€2,098; SE: €1,717) and more QALY were gained (0.0067; SD: 0.0133); yet differences were not statistically significant. The probability of cost-effectiveness was around 80% independent of the willingness-to-pay (range: €0/QALY–€130,000/QALY). The results were robust.ConclusionsA patient-targeted feedback in addition to depression screening in cardiology is cost-effective with a high probability. This underpins the use of the patient-targeted feedbacks and the PHQ-9 that are both freely available and easy to implement in routine care.

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Screening for Depression in Cardiac Rehabilitation

Cited by 22 publications

References 40 publications

Burden, screening, and treatment of depressive and anxious symptoms among women referred to cardiac rehabilitation: a prospective study

Burden, screening, and treatment of depressive and anxious symptoms among women referred to cardiac rehabilitation: a prospective study

Mental illness and obesity among Veterans undergoing percutaneous coronary intervention: Insights from the VA CART program

Depression screening with patient-targeted feedback in cardiology: The cost-effectiveness of DEPSCREEN-INFO

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