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Researchers examine medication effectiveness and depression among cardiac patients

Nearly 5 million people in the United States suffer from heart failure, a major cause of death. Depression, which affects many individuals who suffer from heart failure, heart attack, and other cardiac problems, increases the risk of further cardiac problems in these patients. A new study supported by the Agency for Healthcare Research and Quality (contract 290-97-0001) details medications that are effective for certain types of heart failure patients. A second study (AHRQ grant HS11282) focuses on the optimal timing for assessing depression in patients undergoing coronary bypass surgery or coronary angioplasty. The articles are summarized here.

Shekelle, P.G., Rich, M.W., Morton, S.C., and others (2003, May). "Efficacy of angiotensin-converting enzyme inhibitors and beta blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status." Journal of the American College of Cardiology 41, pp. 1529-1538.

This study found that angiotensin-converting enzyme (ACE) inhibitors and beta-blockers provide life-saving benefits in most heart failure patients. However, women with asymptomatic heart failure may not gain a survival benefit when treated with ACE inhibitors. Data supported beneficial reductions in all-cause death for the use of beta-blockers in men and women, use of ACE inhibitors and some beta-blockers in black and white patients, and the use of ACE inhibitors and beta-blockers in patients with or without diabetes. The findings were based on a meta-analysis of the 12 largest randomized clinical trials on these medications to examine their impact on mortality on heart failure patients.

Poston, W.S., Haddock, C.K., Conard, M.W., and others (2003, January). "Assessing depression in the cardiac patient." Behavior Modification 27(1), p. 26-36.

It is common to screen for depression in patients undergoing coronary artery bypass graft surgery or coronary angioplasty because depression can impair recovery. Some patients experience transient, reactive depression, while others suffer from persistent depression. Patients undergoing coronary revascularization procedures are best screened for depression 1 month after their procedure, according to the results of this study.

The researchers found that 75 percent of the patients who were depressed at 1 month would not have been identified as depressed by a screening questionnaire at the time of their revascularization procedure. Thus, screening at the time of surgery is not as predictive of depression 6 months after the operation as it is 1 month postprocedure. The researchers used questionnaires to identify depression at the time of the procedure and monthly thereafter for up to 6 months among 422 patients undergoing coronary revascularization.

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