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...

Strategies to Improve Medication Adherence

According to recent estimates, about a third to a half of all patients in the United States fail to comply with their prescribed pharmacotherapy regimens. Failure to adhere to medications can reduce quality of care and increase medical expenses. Costs attributable to non-adherence are about $290 billion each year, and much of this spending stems from complications that result from not taking medications appropriately. “Patients fail to take their medications for many reasons, including difficulty with dosing regimens, costs, side effects, or concerns about drugs in general,” says Walid F. Gellad, MD. “Providers need different strategies and interventions to improve adherence.” To achieve optimal medication adherence, considerations must be made with regard to effective patient-provider communication, coordination among care providers, and active engagement and participation by patients. “All too often, patients are lacking important information or there are gaps in their communication with providers,” Dr. Gellad says. “For these reasons, it’s critical to identify any opportunities to remove barriers that keep patients from adhering to their medications.” New Policy Recommendations On July 15, 2009, several organizations convened more than 40 experts to discuss poor medication adherence in the United States, including GlaxoSmithKline, the National Association of Chain Drug Stores Foundation, the National Consumers League, the Pharmaceutical Research and Manufacturers of America, and the American College of Cardiology. As a result of this meeting, consensus policy recommendations to reduce barriers to adherence were released on October 14, 2009. Using themes that emerged from the July 15, 2009 conference and considering the proposed policies under review by Congress, the resulting recommendations focus on the following key areas: quality improvement strategies, care...