Waiting for Godot
Engaging in Discussions About Depression Care in Patients With Acute Myocardial Infarction While Waiting for a Definitive Trial That Never Appears
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Articles, see p 1681and 1762
In patients with an acute myocardial infarction (AMI), depressive symptoms are associated with worse mortality outcomes,1 worse morbidity outcomes,2 worse quality of life outcomes,3 and greater healthcare costs.4 Calls have been issued for depression to be recognized as a risk marker5 and patients with AMI to be regularly screened for depression.6 In fact, the American Heart Association recently recognized depression as a risk factor for poor prognosis among patients with AMI, based on their systematic literature review of depression’s observational association with all-cause mortality, cardiac mortality, and composite end point in patients after an MI.7 Clinicians, confronting this current observational evidence base and set of recommendations, are left to use any of the existing depression identification or treatments for patients with AMI, leading to practice variation and increasing health disparities in care for this prevalent clinical comorbidity.8
On reading about the large, international, multidecade weight of observational evidence supporting the conjecture that depression portends ill for patients with AMI, many queries may cross one’s mind. One logical question to ask, as an interested clinician or scholar, is whether treating depression in these patients would improve these many medical outcomes. A scholar or clinician …