To the Editor: The American Heart Association (AHA) recently recommended routine screening for depression in patients with coronary heart disease.1 Shortly thereafter, Dr Thombs and colleagues2 published a systematic review of the research on depression screening and clinical outcomes in cardiovascular patients. They found no studies that evaluated whether routine screening for depression produces better outcomes in patients with heart disease. They concluded that “the adoption of depression screening in cardiovascular care settings . . . would not be likely to benefit patients in the absence of significant changes in current models of care.” We disagree with some of their conclusions.
Symptoms of depression double the risk for mortality and other cardiac events in patients with coronary disease. The risk is even greater for patients with an interview-based clinical diagnosis of depression.3 Regardless of whether treating depression can improve cardiac outcomes, depression is a cardiac risk marker and its presence warrants more aggressive cardiac care and secondary prevention efforts. Even risk markers that are untreatable, such as age, compel physicians to increase efforts to achieve optimal levels of other more readily treatable risk factors. In addition, depression should be recognized because it is one of the strongest predictors of nonadherence with medical treatment regimens,4 - 5 indicating the need for careful monitoring.
Thombs et al noted that placebo-controlled antidepressant trials have demonstrated only modest efficacy in cardiac patients and offered this as another reason to forgo screening. Yet, as they also noted, antidepressants are just as efficacious in cardiac patients as in depressed but otherwise medically well psychiatric patients. Depression is a debilitating, often chronic, disorder. Patients with heart disease should not be deprived of the benefits of treatments, even if they are only modestly effective.
Finally, the authors concluded that “there are patients with serious and potentially life-threatening depression in most cardiovascular care settings. For these patients, physicians should provide appropriate treatment, referral, or both.” It is not clear how physicians will identify these patients if they do not screen for depression.
Financial Disclosures: Dr Carney reported having received an honorarium from Forest Laboratories and receiving Zoloft from Pfizer for a National Institutes of Health–funded clinical trial. Dr Jaffe reported receiving research support from Dade-Behring, Beckman-Coulter, and Ortho Diagnostics and being a consultant for Dade-Behring, Beckman-Coulter, Ortho Diagnostics, Critical Diagnostics, Liposcience, Bayer, Singulex, Nanosphere, Hoffman LaRoche, and Pfizer. Dr Freedland reported no disclosures.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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