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Docs question AHA depression screening for heart patients

It's been only two months since the American Heart Association (AHA) recommended routine screening of cardiac patients for depression, and already those guidelines are being shot down.

Screening and treating heart patients for depression didn’t improve survival or cardiac health, according to a review of 17 studies published today in the JAMA The Journal of the American Medical Association. In those who showed signs of depression, symptoms improved only slightly — by 1 to 4 percent — with antidepressant drug treatment.

"We cannot in good conscience support screening all heart patients," study co-author Roy Ziegelstein, vice chairman of medicine at Johns Hopkins Bayview Medical Center in Baltimore, said in a statement. "This is a difficult call for us to make, but it is in the best interest of patients at this time" because of its cost, side effects of drug treatment and potentially negative effects of being misdiagnosed as depressed.

Some 30 percent of heart patients have depressive symptoms, according to a 2000 study in the Journal of Psychosomatic Medicine, and 20 percent have major depression that interferes with their functioning, a 2006 study in the Journal of General Internal Medicine showed.

The AHA recommends that heart patients are screened for depressive symptoms with a two- or nine-question survey, then referred for a more detailed workup if they score high on those questions. Patients who are diagnosed with depression should be treated with medication, counseling, exercise, cardiac rehabilitation or a combination, according to the guidelines.

Those guidelines concede that "there is currently no direct evidence that screening for depression leads to improved outcomes in cardiovascular populations." But they say that screening is worth it because depression is associated with a doubled risk of cardiac problems in the first two years after a heart attack, as well as diminished quality of life.

"The feeling is so powerful that depressed people are living such poor quality of lives that it's not that you'll die of the disease, but that you'll be unhappy for the time you're alive," says Richard Stein, an AHA spokesman and director of urban cardiology at N.Y.U. School of Medicine. "Is there enough of a clinical rationale of treating [their depression]? The feeling of the AHA is, yes, there is."

Image by iStockphoto/Don Bayley

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