Depression a risk factor for adverse outcomes in ACS patients

Depression should be considered as a risk factor for adverse outcomes in patients with acute coronary syndrome (ACS), according to a new scientific statement from the American Heart Association (AHA).

To support the recommendation, the AHA writing group conducted a systematic review of the literature on depression and adverse outcomes after ACS. In total, 53 studies and 4 meta-analyses were included. Thirty-two of the studies assessed the association between depression and all-cause mortality after ACS, and 21 of them suggested that depression was a risk factor. Twelve studies looked specifically at cardiac mortality, and 8 of them found depression to be a risk factor. When a composite of fatal and nonfatal cardiac events was the endpoint, 17 of 22 studies showed that depression increased risk. The meta-analyses varied but generally found an association between depression and worse outcomes.

The reviewers noted that the studies were heterogeneous, with differences in inclusion criteria, depression assessment, depression subtypes, and risk adjustment. However, they concluded that there is sufficient evidence to support the AHA (and other health organizations) elevating depression to the status of a risk factor for adverse outcomes in ACS. The scientific statement was published by Circulation on Feb. 24.

Evidence is lacking on whether depression treatment improves survival in ACS patients, the writing group noted, although worsening depression is associated with worsening outcomes. They called for more research into the risks and benefits of screening and treatment of depression in ACS patients. Future research should also identify the highest-risk subtypes of depression, the role of other psychiatric conditions, and the biobehavioral mediators of depression's effect on cardiac outcomes, the statement said.