Depression screening after ACS does not change outcomes

Background: Depression after ACS is common and is associated with increased mortality. Professional societies have recommended routine depression screening in these patients; however, this has not been consistently implemented because there is a lack of data to support routine screening.

Study design: Multicenter randomized clinical trial.

Setting: Four geographically diverse health systems in the United States.

Synopsis: In the CODIACS-QoL trial, 1,500 patients were randomized to three groups within 12 months of documented ACS: depression screening with notification to primary care and treatment, screening and notification to primary care, and no screening. Only 7.7% of the patients in the screen, notify, and treat group and 6.6% of screen and notify group screened positive for depression. There were no differences for the primary outcome of quality-adjusted life-years or the secondary outcome of depression-free days between groups. Additionally, there was no difference in mortality or patient-reported harms of screening between groups. The study excluded patients who already had a history of depression, psychiatric history, or other severe life-threatening medical conditions, which may have affected the outcomes.

Depression remains a substantial factor in coronary disease and quality of life; however, systematic depression screening appears to have limited population-level benefits.

Bottom line: Systematic depression screening with or without treatment offerings did not alter quality of life, depression-free days, or mortality in patients with ACS.

Citation: Kronish IM et al. Effect of depression screening after acute coronary syndrome on quality of life. JAMA Intern Med. 2020;180(1):45-53.

Dr. Ciarkowski is a hospitalist and clinical instructor of medicine at the University of Utah, Salt Lake City.

Background: Depression after ACS is common and is associated with increased mortality. Professional societies have recommended routine depression screening in these patients; however, this has not been consistently implemented because there is a lack of data to support routine screening.

Study design: Multicenter randomized clinical trial.

Setting: Four geographically diverse health systems in the United States.

Synopsis: In the CODIACS-QoL trial, 1,500 patients were randomized to three groups within 12 months of documented ACS: depression screening with notification to primary care and treatment, screening and notification to primary care, and no screening. Only 7.7% of the patients in the screen, notify, and treat group and 6.6% of screen and notify group screened positive for depression. There were no differences for the primary outcome of quality-adjusted life-years or the secondary outcome of depression-free days between groups. Additionally, there was no difference in mortality or patient-reported harms of screening between groups. The study excluded patients who already had a history of depression, psychiatric history, or other severe life-threatening medical conditions, which may have affected the outcomes.

Depression remains a substantial factor in coronary disease and quality of life; however, systematic depression screening appears to have limited population-level benefits.

Bottom line: Systematic depression screening with or without treatment offerings did not alter quality of life, depression-free days, or mortality in patients with ACS.

Citation: Kronish IM et al. Effect of depression screening after acute coronary syndrome on quality of life. JAMA Intern Med. 2020;180(1):45-53.

Dr. Ciarkowski is a hospitalist and clinical instructor of medicine at the University of Utah, Salt Lake City.

Background: Depression after ACS is common and is associated with increased mortality. Professional societies have recommended routine depression screening in these patients; however, this has not been consistently implemented because there is a lack of data to support routine screening.

Study design: Multicenter randomized clinical trial.

Setting: Four geographically diverse health systems in the United States.

Synopsis: In the CODIACS-QoL trial, 1,500 patients were randomized to three groups within 12 months of documented ACS: depression screening with notification to primary care and treatment, screening and notification to primary care, and no screening. Only 7.7% of the patients in the screen, notify, and treat group and 6.6% of screen and notify group screened positive for depression. There were no differences for the primary outcome of quality-adjusted life-years or the secondary outcome of depression-free days between groups. Additionally, there was no difference in mortality or patient-reported harms of screening between groups. The study excluded patients who already had a history of depression, psychiatric history, or other severe life-threatening medical conditions, which may have affected the outcomes.

Depression remains a substantial factor in coronary disease and quality of life; however, systematic depression screening appears to have limited population-level benefits.

Bottom line: Systematic depression screening with or without treatment offerings did not alter quality of life, depression-free days, or mortality in patients with ACS.

Citation: Kronish IM et al. Effect of depression screening after acute coronary syndrome on quality of life. JAMA Intern Med. 2020;180(1):45-53.

Dr. Ciarkowski is a hospitalist and clinical instructor of medicine at the University of Utah, Salt Lake City.