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Managing Depression After Acute Coronary Syndrome

Managing Depression After Acute Coronary Syndrome

Each year, about 1.2 million Americans survive an acute coronary syndrome (ACS) event, many of whom have clinically significant and persistent depression. “Post- ACS depression has been associated with higher risk of ACS recurrence and a doubling of increased risk of all-cause mortality,” explains Karina W. Davidson, PhD. “Persistent depression after an ACS event correlates with an even higher morbidity and mortality risk. Considering its burden on the healthcare system, efforts to reduce persistent post- ACS depression are important.” Despite knowledge of these associations, routine management of depression after ACS events remains poor. Historically, clinicians have been inefficient in screening for depression and lack effective approaches to treating it. Further compounding the problem are the weak effects often linked to depression treatments and limited options if initial therapies and efforts fail. For patients who have had an ACS event, psychotherapy and/or psychotropic medications are oftentimes not integrated into care. The CODIACS Vanguard Trial At ACC.13, Dr. Davidson and colleagues presented results from the Comparison of Depression Interventions after Acute Coronary Syndrome (CODIACS) Vanguard trial. It was designed to determine the feasibility, efficacy, and costs of a centralized, stepped, patient preference–based depression care system for patients after experiencing an ACS event. The study, which was also published in JAMA Internal Medicine, involved 150 patients who had depression scores of 10 or higher (out of 60) on the Beck Depression Inventory (BDI) scale 2 to 6 months after an ACS event. “CODIACS Vanguard was designed to provide depression treatment several months after an ACS,” explains Dr. Davidson, who was lead author of the trial. “This is when most transient depressive reactions...
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