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

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.

Primary Funding Source:

Agency for Healthcare Research and Quality (PROSPERO: CRD42016047032).

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