Depression screenings urged for heart patients

DALLAS — Heart patients should be regularly screened for signs of depression, the American Heart Association recommended Monday.

Depression is about three times more common in heart attack survivors and those hospitalized with heart problems than the general population, according to the recommendations published in the journal Circulation. The authors said only about half of heart doctors say they treat depression in their patients — and not all those diagnosed with depression are treated.

"I think we could reduce considerable suffering and improve outcomes," by screening, said Erika Froelicher, professor of nursing at the University of California, San Francisco. "I know we can do more."

While there's no direct evidence that heart patients who are screened fare better, depression can result in poorer outcomes and a poorer quality of life, the panel said. Depressed patients may skip their medications, not change their diet or exercise or take part in rehabilitation programs, they said.

Anyone from cardiologists to nurses to primary care doctors can and should be involved in determining whether a patient is depressed, said Froelicher, who was co-chairwoman of the panel that wrote the recommendations.

The panel suggests that heart patients be screened by first asking two standard questions: In the past two weeks, have you had little interest or pleasure in doing things? Have you felt down, depressed or hopeless?

If the patient answers yes to one or both, a questionnaire is recommended to determine if the patient is depressed and the severity. If depression is indicated, the patient may need to see a professional qualified in treating depression, the panel said, adding that treatment options include antidepressants, seeing a psychotherapist and exercise.

"Some physicians are qualified to treat it — others may be more comfortable referring the problem to a qualified mental health professional," Froelicher said.

Psychiatrist Michelle Riba said the statement's emphasis on frequent screening is important.

"What you want to see in a particular patient is how they do over time," said Riba, past president of the American Psychiatric Association, which has endorsed the heart association's recommendations.

One doctor said screening isn't enough; patients need close monitoring to make sure they get help.

"A lot of patients with depression don't follow up on it," said Dr. Mary Whooley, a professor of medicine at the University of California, San Francisco, who was not on the panel.