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AHRQ releases evidence reports on depression among heart attack patients and three other topics

The Agency for Healthcare Research and Quality recently released evidence reports and summaries on the incidence of depression following a heart attack, management of chronic insomnia in adults, acute bacterial rhinosinusitis, and recruitment of underrepresented populations to cancer clinical trials.

The reports were prepared by Evidence-based Practice Centers (EPCs) supported by AHRQ. There are 13 AHRQ-supported EPCs. They systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments.

The goal is to inform health plans, providers, purchasers, and the health care system as a whole by providing essential information to improve health care quality. All of AHRQ's EPC reports, as well as several technical reviews, that have been published to date are available online and through the AHRQ Publications Clearinghouse.

Post-Myocardial Infarction Depression. Evidence Report/Technology Assessment No. 123 (AHRQ Publication Nos. 05-E018-1, summary and 05-E018-2, full report). Available from the AHRQ Publications Clearinghouse.

One in five patients hospitalized for heart attack suffers from major depression, and these patients may be more likely than other heart attack patients to need hospital care again within a year for a cardiac problem. They also are three times as likely as other heart attack patients to die from a future attack or other heart problems, according to a new evidence report by the Agency for Healthcare Research and Quality. The American Academy of Family Physicians, which requested the evidence review, plans to use the report to develop evidence-based clinical practice guidelines.

The scientific evidence review on which the report is based suggests that 60 percent to 70 percent of individuals who become depressed when hospitalized for heart attack continue to suffer from depression for 1 month to 4 months or more after discharge. Major depression lasts 2 weeks or longer and is accompanied by five or more symptoms—including feelings of sadness, hopelessness, pessimism, and a general loss of interest in life—that hinder a person's ability to carry out normal, everyday activities.

The reviewers also found that during the first year following a heart attack, those with major depression can have a delay in returning to work, worse quality of life, and worse physical and psychological health compared with heart attack survivors who do not have major depression. In fact, some studies show that depression that begins while the patient is hospitalized can continue to affect his or her psychological and physical health for as long as 5 years after discharge. Approximately 765,000 Americans were discharged following treatment for heart attacks in 2002, according to national hospital data from AHRQ.

The reviewers found strong evidence that both counseling and certain antidepressants, such as selective serotonin reuptake inhibitors, are effective at reducing symptoms of depression in patients following a heart attack, but there is no evidence that either therapy reduces the likelihood of suffering future cardiac events or the odds of dying from them.

Reviewers at the AHRQ-supported Johns Hopkins University Evidence-based Practice Center in Baltimore, led by David E. Bush, M.D., and Roy C. Ziegelstein, M.D., could not determine whether depression influences the frequency of needing prescription medicines for cardiac problems or cardiac procedures. However, they did find relatively strong evidence that patients with post-heart attack depression are less likely than other heart attack survivors to take their medications as instructed or to follow doctors' advice for helping to prevent future heart attacks by losing weight, reducing salt consumption, or exercising, for example.

The reviewers found insufficient evidence to adequately assess the performance of methods used to screen patients for depression while they are hospitalized for heart attack. However, the reviewers found that most of the commonly used screening instruments and rating scales are accurate enough to identify depression when used within 3 months after the patient's initial hospitalization for heart attack.

The reviewers call for additional research to expand the evidence base, including studies to determine the major causes of death among depressed post-heart attack patients, whether treatment improves their outcomes relative to similar patients not suffering from depression, and the definition of the most clinically relevant measure of depression during initial heart attack hospitalization.

Other recent reports have been issued on the following topics:

Knowledge and Access to Information on Recruitment of Underrepresented Populations to Cancer Clinical Trials. Evidence Report/Technology Assessment No. 122 (AHRQ Publication No. 05-E019-1, summary and 05-E019-2, full report). Available from the AHRQ Publications Clearinghouse.

Update on Acute Bacterial Rhinosinusitis. Evidence Report/Technology Assessment No. 124 (AHRQ Publication No. 05-E020-1, summary and 05-E020-2, full report). Available from the AHRQ Publications Clearinghouse.

Manifestations and Management of Chronic Insomnia in Adults. Evidence Report/Technology Assessment No. 125 (AHRQ Publication No. 05-E021-1, summary and 05-E021-2, full report). Available from the AHRQ Publications Clearinghouse.

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