Depressive symptoms and treatment after acute coronary syndrome

Background There is limited data regarding the effects of depression treatment adequacy on the mental component of health-related quality of life in a post-acute coronary syndrome population. Methods All patients diagnosed with an acute coronary syndrome and discharged from a university-affiliated hospital during a 3-year period were mailed a survey that included the SF-8, EQ-5D and other self-reported measures of disease and treatment (e.g. physical functioning, comorbidity, medication compliance and perceived cardiac severity). Patients were categorized based on self-report of depressive symptoms and antidepressant medication. Adjusted mean mental health-related quality of life scores were determined by least square mean analysis controlling for independent variables. Results Of 1217 eligible patients, 490 (40.3%) responded. Respondents averaged 65.2 (±11.3) years of age, 71% male, 92% Caucasian, 64% with MI history, 17% had their most recent cardiac event within 6 months. No depressive symptoms and no depression treatment (without depression) were reported by 59.8%, 27.6% reported untreated depressive symptoms (untreated), 8.6% reported depressive symptoms and antidepressant medication (undertreated), and 4.1% reported no symptoms and antidepressant medication (adequately treated). Adjusted mean SF-8 Mental Component Summary scores were 52.8, 52.5, 42.8 and 40.2 for patients without depression, adequately treated, untreated and undertreated, respectively (p<0.0001 for all pairwise comparisons except for patients without depression vs. adequately treated and untreated vs. undertreated). Conclusions Depressive symptoms are common in patients diagnosed with acute coronary syndrome and appear to be related to lower mental health-related quality of life. These observations stress the importance of diagnosis and treatment of depression in this population.