Topic Nomination PostMyocardial Infarction MI Depression Updated Evidence ReviewKey Questions What is the independent association of measures of depression with postMI outcomesDoes treatment of postMI depression improve outcomesWhat are the performance characteristics of depression measures postMIWhat is the comparative effectiveness of screening tools for depression postMIPatient population adults who have sustained STelevation MI STEMI or nonSTelevationMI NSTEMI

Depression is an important predictor of morbidity and mortality in patients with coronary heart disease particularly after myocardial infarction independent of previous cardiac history.1 As many as 65 of patients with acute myocardial infarction report experiencing symptoms of depression and major depression is present in 15 to 22 of these patients.23 In the time since the previous evidence review was completed4 numerous new studies and analyses of several clinical trials have been published. These studies still shown an association of depression postMI however there are discrepancies between selfreporting and clinical diagnostic interview instruments.5 There are also studies outlining the potential for somatic symptoms to have a greater impact on patient outcomes than cognitive symptoms.6 An updated evidence report on the appropriate screening methodologies the effectiveness of screening for depression and the effectiveness of treatment on patient outcomes would provide crucial and timely guidance for primary care physicians.1.Jaffe AS et al. 2006. Prediction of medical morbidity and mortality after acute myocardial infarction in patients at increased psychosocial risk in the Enhancing Recovery in Coronary Heart Disease Patients ENRICHD study. Am Heart J. 5121126135.2.Thombs BD et al. 2006. Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med. 211 3038.3.Guck TP et al. 2001. Assessment and treatment of depression following myocardial infarction. Am Fam Physician. 644 641648.4.Bush D et al. 2005. Postmyocardial infarction depression. Evidence reporttechnology assessment No. 123 Prepared by the Johns Hopkins University EvidenceBased Practice Center under contract No. 290020018. ARHQ Publication No. 05E0182. Rockville MD Agency for Healthcare and Research Quality.5.Meijer A et al. 2011. Prognostic associate of depression following myocardial infarction with mortality and cardiovascular events a metaanalysis of 25 years of research. Gen Hosp Psych. 333 203216.6.Roest AM et al. 2013. Changes in cognitive versus somatic symptoms of depression and eventfree survival following myocardial infarction in the Enhancing Recovery in Coronary Heart Disease ENRICHD trial. J Affect Disord. 149 335341.

The updated evidence report will be used to inform relevant updates to the American Academy of Family Physicians AAFP clinical practice guideline for primary care physicians on screening and treatment of depression resulting after myocardial infarction.

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The AAFP has a long standing relationship with the Effective Health Care Program. This particular topic was discussed with Drs. Yenpin Chiang Stephanie Chang and Supriya Janakiraman.