Check All Heart Patients for Depression?
Heart Disease and Depression Are Common; New Recommendations Call for Universal Screening
Sept. 29, 2008 -- Heart disease and depression are so common that all heart
patients should be routinely screened for depression and referred for
professional help if necessary, according to new recommendations issued by the
American Heart Association.
The recommendations were spurred by growing evidence suggesting that
depression is common among cardiac patients and that the condition can worsen
patients' outcomes, making them more vulnerable to continuing or recurrent
This is the Heart Association's first "call to action" addressing
cardiac patients and depression, says Erika Froelicher, RN, MPH, PHD, professor
of nursing and epidemiology and statistics at the University of California, San
Francisco and co-chair of the writing group that created the
"The call for action is for health care providers who deal with cardiac
patients," she tells WebMD, and that includes doctors, nurses, and many
other health care professionals.
The hope, she says, is that routine screening for depression will be done on
every cardiac patient. "I believe a lot of depressed cardiac patients are
overlooked," Froelicher says. "Unless you screen formally, you can miss
a lot of people."
The American Psychiatric Association has endorsed the new recommendations,
published in the Oct. 21 issue of Circulation: Journal of the American Heart
Heart Disease & Depression: The Problem
Depression is about three times more common in patients after an attack than
in the general population, and it can also occur with other types of heart
problems. Many studies have found that depression is linked to a worse outcome
in heart patients, who are more apt to have repeat heart attacks, for
Heart Disease & Depression: The Recommendations
Among the new AHA recommendations:
- Administer a two-item questionnaire, asking the patient: "Over the past
two weeks, how often have you been bothered by any of the following problems?
(1) Little interest or pleasure in doing things. (2) Feeling down, depressed,
- If a patient answers in the affirmative to either question, screening with
a more comprehensive questionnaire is recommended. The second questionnaire
includes nine items, asking about feelings of hopelessness, changes in appetite
or sleep habits, problems concentrating, and any instances of suicidal
Patients who score high on the second questionnaire should be referred to a
professional qualified in the diagnosis and management of depression. Cardiac
care providers can also elect to refer patients to depression specialists if
they answer in the affirmative on the initial two-question assessment.
In the advisory, the experts lay out the treatment options but leave it to
health care providers to tailor the treatments to individual patients. Among
the options to treat depression are antidepressant drugs, behavior or talk
therapy, and physical activity recommendations.
If medications are required, the antidepressants Zoloft and Celexa are
considered good first choices, the authors say, as research has shown they are
generally safe for cardiac patients.