Patients with an acute coronary syndrome (ACS) and comorbid depression have a 2-fold higher risk for recurrent ACS and mortality, worse quality of life, and higher costs of care than nondepressed ACS patients. The strength of these observational findings prompted the American Heart Association (AHA) to advise that routine depression screening for ACS patients and referral for depression diagnosis and treatment as indicated occur. Unfortunately, there are no randomized controlled trials (RCT) to inform this large, potentially expensive screening recommendation. And, screening guidelines/advisories in the absence of RCT evidence have recently been extensively criticized (and withdrawn). This poses a serious dilemma for clinicians, health care systems, and for health care policy leaders. A RCT is urgently needed to provide evidence for these different constituents about the costs and benefits of the AHA depression screen and treat algorithm. Two critical gaps in knowledge must be filled to determine if public health would be improved by the AHA strategy for depression screening in post-ACS patients: 1) Does this strategy improve quality-adjusted life years for patients with a recent ACS? 2) Is the cost of providing depression screening and any type of depression treatment within the acceptable and typical amounts reimbursed for health care services? Our specific aim is to determine the quality-adjusted life year benefits and health care costs of following the AHA's advisory for depression screening and then referral for further diagnosis and treatment in post-ACS patients, if depression is found. To accomplish this aim, we will randomize patients from three different, geographically diverse health maintenance organizations to three different groups: 1) to the AHA depression screen and treat if depression is found algorithm (intervention group) or: 2) to receive no depression screening (strong control group) or: 3) to be screened and a primary care provider notified (minimally enhanced control group). Health-related quality of life, depressive symptoms, and costs will be obtained from all patients, so that the benefits and the costs of these three different depression screening strategies can be compared.

Public Health Relevance

Depression and acute coronary syndromes (ACS) carry large world-wide public health burden, and their comorbidity is common. Multitudes of observational studies have convinced leading authorities to advise that ACS patients should be screened for depression, and then treated if it is detected. No randomized controlled trial exists to directly tst if this strategy improves any outcome. This research is significant because it will provide vital randomized controlled trial data on cost-effectiveness and quality of life to inform national screening guidelines about the usefulness of depression screening and treatment in ACS patients.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
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Czajkowski, Susan
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Columbia University (N.Y.)
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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Moise, Nathalie; Bertoni, Alain G (2018) Invited Commentary: Sex and Race Differences in Diabetes and Cardiovascular Disease-Achieving the Promise of Sex and Race Subgroup Analyses in Epidemiologic Research. Am J Epidemiol 187:411-414
Moise, Nathalie; Khodneva, Yulia; Jannat-Khah, Deanna Pereira et al. (2018) Observational study of the differential impact of time-varying depressive symptoms on all-cause and cause-specific mortality by health status in community-dwelling adults: the REGARDS study. BMJ Open 8:e017385
Moise, Nathalie; Falzon, Louise; Obi, Megan et al. (2018) Interventions to Increase Depression Treatment Initiation in Primary Care Patients: a Systematic Review. J Gen Intern Med 33:1978-1989
Moise, Nathalie; Ye, Siqin; Alcántara, Carmela et al. (2017) Depressive symptoms and decision-making preferences in patients with comorbid illnesses. J Psychosom Res 92:63-66
Gallagher, Benjamin D; Moise, Nathalie; Haerizadeh, Mytra et al. (2017) Telemonitoring Adherence to Medications in Heart Failure Patients (TEAM-HF): A Pilot Randomized Clinical Trial. J Card Fail 23:345-349
Moise, Nathalie; Khodneva, Yulia; Richman, Joshua et al. (2016) Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study. J Am Heart Assoc 5:
Kronish, Ian M; Moise, Nathalie; McGinn, Thomas et al. (2016) An Electronic Adherence Measurement Intervention to Reduce Clinical Inertia in the Treatment of Uncontrolled Hypertension: The MATCH Cluster Randomized Clinical Trial. J Gen Intern Med 31:1294-1300
Suls, Jerry; Green, Paige A; Davidson, Karina W (2016) A Biobehavioral Framework to Address the Emerging Challenge of Multimorbidity. Psychosom Med 78:281-9
Alcántara, Carmela; Biggs, Mary L; Davidson, Karina W et al. (2016) Sleep Disturbances and Depression in the Multi-Ethnic Study of Atherosclerosis. Sleep 39:915-25
Haerizadeh, Mytra; Moise, Nathalie; Chang, Bernard P et al. (2016) Depression and doctor-patient communication in the emergency department. Gen Hosp Psychiatry 42:49-53

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