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CODIACS-QoL: Depression screening fails to improve quality of life post-ACS
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NEW ORLEANS — Patients with ACS who were screened for depression either with or without provision of depression treatment after screening positive did not have a change in depressive symptoms or quality-adjusted life-years at 18-month follow-up, according to data from the CODIACS-QoL trial presented at the American College of Cardiology Scientific Session.
In addition, these patients did not have an increase in harms, including mortality or self-reported bleeding, appetite changes, drowsiness or GI upset across follow-up. In total, 4.5% of patients died over 18 months.
Ian M. Kronish, MD, Florence Irving Associate Professor of Medicine at Columbia University Medical Center, and colleagues analyzed data from 1,500 patients at four U.S. health care systems who had ACS within the previous 2 to 12 months and no prior history of depression. Patients were assigned one of three approaches:
- screen, notify and treat (n = 499; mean age, 66 years; 72% men);
- screen and notify (n = 501; mean age, 66 years; 73% men); and
- no screen (n = 500; mean age, 66 years; 71% men).
In the two depression screening groups, researchers used the eight-item Patient Health Questionnaire to identify depression. If patients screened positive for depression, with a score of 10 or higher, then the treating providers of patients in both depression screening groups were notified about patients’ positive depression screen. In the depression screen, notify and treat group, patients were additionally provided with depression treatment through the study at no cost to patients. Depression treatment consisted of either antidepressant medications, problem-solving therapy or both, according to patients’ preference, and patients who were provided depression treatment by the study had their treatment carefully adjusted until depressive symptoms remitted. Patients in all three groups were followed up at 6, 12 and 18 months to undergo assessments of depressive symptoms, quality of life and potential harms associated with antidepressant treatment.
The primary outcome of interest was change in QALYs from baseline to 18 months. Secondary outcomes of interest were cumulative depression-free days across 18 months and depressive symptoms measured by the 10-item Center for Epidemiological Studies Depression Scale.
Screening identified depression in 7.6% of patients in the screen, notify and treat group and in 6.6% of patients in the screen and notify group. Of 38 patients who screened positive for depression in the screen, notify and treat group that were treated, 14 chose problem-solving therapy, four chose medications, 10 chose problem-solving therapy and medications, and 10 declined treatment from study providers, but may have received depression treatment elsewhere.
The researchers reported no separation regarding depressive symptoms and depression-free days in all three groups during the study (P = .63). This was also observed in all three groups for mean utility score and change in QALYs up to 18 months (P = .91), according to the researchers.
“These findings suggest that systematic depression screening, at least in the manner conducted in this trial, may not be warranted,” Kronish said during the presentation. “Depression screening guidelines in ACS patients may need to be reconsidered.” – by Darlene Dobkowski
Reference:
Kronish IM, et al. Featured Clinical Research I. Presented at: American College of Cardiology Scientific Session; March 16-18, 2019; New Orleans.
Disclosure: Kronish reports no relevant financial disclosures.