Diagnostic Accuracy of Screening Tests and Treatment for Post-Acute Coronary Syndrome Depression: A Systematic Review.

Nieuwsma JA1, Williams JW Jr1, Namdari N1, Washam JB1, Raitz G1, Blumenthal JA1, Jiang W1, Yapa R1, McBroom AJ1, Lallinger K1, Schmidt R1, Kosinski AS1, Sanders GD1.

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Abstract

BACKGROUND:

Patients who have had an acute coronary syndrome (ACS) event have an increased risk for depression.

PURPOSE:

To evaluate the diagnostic accuracy of depression screening instruments and to compare safety and effectiveness of depression treatments in adults within 3 months of an ACS event.

DATA SOURCES:

MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews from January 2003 to August 2017, and a manual search of citations from key primary and review articles.

STUDY SELECTION:

English-language studies of post-ACS patients that evaluated the diagnostic accuracy of depression screening tools or compared the safety and effectiveness of a broad range of pharmacologic and nonpharmacologic depression treatments.

DATA EXTRACTION:

2 investigators independently screened each article for inclusion; abstracted the data; and rated the quality, applicability, and strength of evidence.

DATA SYNTHESIS:

Evidence from 6 of the 10 included studies showed that a range of depression screening instruments produces acceptable levels of diagnostic sensitivity, specificity, and negative predictive values (70% to 100%) but low positive predictive values (below 50%). The Beck Depression Inventory-II was the most studied tool. A large study found that a combination of cognitive behavioral therapy (CBT) and antidepressant medication improved depression symptoms, mental health-related function, and overall life satisfaction more than usual care.

LIMITATION:

Few studies, no evaluation of the influence of screening on clinical outcomes, and no studies addressing several clinical interventions of interest.

CONCLUSION:

Depression screening instruments produce diagnostic accuracy metrics that are similar in post-ACS patients and other clinical populations. Depression interventions have an uncertain effect on cardiovascular outcomes, but CBT combined with antidepressant medication produces modest improvement in psychosocial outcomes.