Acute Care/Hospitalization

Moderate to severe depressive symptoms are poorly recognized in hospitalized patients with acute coronary syndrome

Many patients with acute coronary syndrome (ACS, unstable angina or heart attack) suffer from major depression. Depression is associated with worse quality of life, recurrent cardiac events, poor treatment adherence, and higher rates of death among patients with ACS. Yet moderate to severe depressive symptoms are poorly recognized in patients hospitalized with ACS, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11282). Researchers found that 18 percent of patients hospitalized with ACS suffered from moderate or severe depressive symptoms; however, depression was recognized in documentation from hospital records in only one of every four of these patients.

Minority patients were nearly 7 times more likely to have their depressive symptoms unrecognized than white patients, and those with no college education were nearly 3 times more likely to have their depressive symptoms unrecognized than those with some college. Finally, patients with an ejection fraction (EF) of less than 40 percent were over 3 times more likely to have unrecognized depressive symptoms than those with an EF of 40 percent or more. EF is the proportion of blood pumped out of the left ventricle with each heart beat. An EF of less than 40 percent is one indicator of a weak heart.

Poor recognition of depression among patients with an EF of less than 40 percent may have been due to physicians ascribing symptoms of fatigue, poor concentration, and poor appetite to their low EF as opposed to depression. Researchers used a Patient Health Questionnaire to assess the presence of 9 depressive symptoms and their frequency among 1,181 patients with confirmed ACS at 2 Kansas City hospitals. They also reviewed patients' hospital records for documentation of depressive symptoms (diagnosis or antidepressant prescription).

See "The prevalence of unrecognized depression in patients with acute coronary syndrome," by Alpesh A. Amin, M.D., Angela M.H. Jones, M.S., Karen Nugent, R.R.T., and others, in the November 2006 American Heart Journal 152, pp. 928-934.

Editor's note: Another AHRQ-supported study on a related topic found that ACS patients involved in goal-setting programs after hospitalization tend to select goals most appropriate to improving their health. For example, smokers chose quitting smoking as a goal, while overweight patients chose dietary modification. For more details, see Holtrop, J.S., Corser, W., Jones, G., and others (2006, July). "Health behavior goals of cardiac patients after hospitalization."(AHRQ grant HS11282). American Journal of Health Behavior 30(4), pp. 387-399.

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