NEW ORLEANS – Underrecognition and undertreatment of clinically significant depression among patients with acute coronary syndrome is common–and strikingly more so among black patients, Alpesh A. Amin, M.D., reported at the annual scientific sessions of the American Heart Association.
Among 1,181 patients who were hospitalized with acute coronary syndrome (ACS) at two major Kansas City-area medical centers, the prevalence of moderate to severe depressive symptoms as assessed by trained evaluators using the Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire was 14.9% among the 80.3% of ACS patients who were white–and fully twice as great in the 16.4% of patients who were black.
Yet these significant depressive symptoms were three times as likely to go unrecognized by clinicians in black than in white patients, said Dr. Amin, a research fellow at the Saint Luke's Hospital Center for Innovation and Research and the University of Missouri, Kansas City.
Moreover, the racial disparity in treatment of depression was even more pronounced than the disparity in recognition. Only 3.6% of black patients with moderate to severe depressive symptoms were discharged on antidepressant medication, compared with 28.5% of depressed white patients.
Depressive symptoms were recognized by clinicians in just 10.3% of black patients with moderate to severe depressive symptom scores, compared with 31.2% of affected white patients.
Recognizing depression should be an important goal for any physician who provides care for patients with ACS, Dr. Amin stressed. Depressed ACS patients have been shown to have a greater risk of future cardiac events and death than nondepressed ones. Plus, the psychologic, social, and functional impairment inflicted by depression make depressive symptoms in patients with ACS worthy of treatment, regardless of whether antidepressant therapy improves cardiovascular outcomes, an issue currently under study.