The prevalence of unrecognized depression in patients with acute coronary syndrome

Background: Depression in patients with acute coronary syndrome (ACS) is common and independently prognostic of a higher mortality and worse health status. Despite great attention to its prevalence and prognostic import, little is known about how often hospitalized patients with ACS who have significant depressive symptoms are recognized while receiving routine cardiovascular care. Methods: We performed a cross-sectional study of 1181 consecutive patients with confirmed ACS. Detailed reviews of hospital records were performed for the documentation that depressive symptoms were recognized. Multivariable regression analysis was used to identify factors associated with unrecognized depressive symptoms. Results: The prevalence of moderate/severe depressive symptoms was 17.6%. Only 24.5% had documentation that their depressive symptoms were recognized. In multivariable regression analysis, characteristics associated with unrecognized depressive symptoms were race (minorities vs whites; odds ratio [OR] = 6.73, 95% confidence interval [CI] 2.62-19.33), ejection fraction (EF < 0.40 vs EF ≥ 0.40; OR = 3.45, 95% CI 1.06-11.23), and education level (no college vs some college; OR = 2.77, 95% CI 1.38-5.69). Conclusions: Despite its prognostic importance and prevalence, moderate to severe depressive symptoms are poorly recognized in hospitalized patients with ACS. Better interventions are warranted to increase the recognition and improve the management of depressive symptoms in patients with ACS.