Findings Highlight Depression, MI Connections

Article excerpt

Depression strikes one in five patients hospitalized for myocardial infarction, with severe consequences, including a threefold increased risk of cardiac mortality and significantly elevated mortality from all causes, a comprehensive evidence review has concluded.

The review, conducted by the federal Agency for Healthcare Research and Quality at the behest of the American Academy of Family Physicians, is destined to become the framework for evidence-based clinical practice guidelines, according to the AAFP.

Highlights of the review coordinated by the Johns Hopkins Evidence-Based Practice Center in Baltimore include:

* Evidence from 25 trials pointing to a prevalence of depression in one in five patients hospitalized for an MI.

* Data from three studies that depression during the initial MI hospitalization persists from 1-4 months in 60%-70% of patients.

* "Strikingly consistent" evidence that post-MI depression puts patients at an increased risk for death by cardiac causes (a threefold increased risk) and other causes.

* Conclusions from three studies showing that depressed post-MI patients are less likely than are others to take their prescribed medications or to comply with lifestyle modification.

* Findings that suggest psychosocial intervention and selective serotonin reuptake inhibitors (SSRIs) improve depression in post-MI patients, but not necessarily other outcomes.

The lengthy analysis pointed out a number of important gaps in scientific knowledge about depression and MI, such as the best way to measure depression in hospitalized MI patients and the true impact of interventions.

For example, SSRIs were found to improve some surrogate markers of cardiac risk, "but no studies of sufficient power address the question of whether this treatment improves survival," the analysis said.

The Johns Hopkins team, led by Dr. David E. Bush and Dr. …