There is great interest in screening in cardiovascular settings but little evidence that implementation of screening will affect depression or cardiac outcomes despite the epidemiologic evidence that depression predicts cardiac events and mortality. Since this chapter was accepted, in October 2008 the American Heart Association (AHA) Working Group published a Scientific Advisory recommending that all patients with cardiovascular disease be screened for depression, although this recommendation was not based on a systematic review of the evidence. Several weeks after release of the Scientific Advisory, a systematic review of depression screening in cardiovascular care was published but did not find evidence that patients with cardiovascular disease would benefit from screening for depression. The authors of the review noted that no published trials have assessed whether screening for depression improves depressive symptoms or cardiac outcomes in patients with cardiovascular disease, suggesting that the recommendations of the AHA Scientific Advisory were premature. High rates of depression were first documented among patients with cardiovascular disease (CVD) in the late 1960s. Early research on depression in CVD focused on patients with acute myocardial infarction (AMI) and conceptualized depression as an acute reaction to a catastrophic medical event. In the 1990s, groundbreaking work by Frasure-Smith and colleagues demonstrated a connection between major depression during hospitalization for AMI and subsequent mortality. Since then, many other studies have identified major depression or depressive symptoms as risk factors for mortality and recurrent cardiac events among patients with AMI or unstable angina pectoris (together known as acute coronary syndromes [ACS]) even after controlling for other known risk factors, although not all studies have reported a significant association. Other studies have reported that depression among patients with ACS is related to decreased quality of life and poor adherence to secondary prevention behaviors, including smoking cessation, taking prescribed medications, exercising, and attending cardiac rehabilitation. Less research on the relationship between depression and mortality has been done in other CVD patient groups, although similar links have been reported in studies of patients with congestive heart failure (CHF), for instance.
Role of CMV & Interferon-? in Myocardial Infarction, Angina and Hypertension
