Depression and CV disease

Question 1

depression predicts ___

Answer 1

incident CV disease and mortality after ACS

first MI and cardiac death in people w/o CVD

Question 2

___ predicts incident CV disease

Answer 2

depression

Question 3

is depression common in people with CV disease

Answer 3

yes 20-30%

in patients with CAD –> post ACS

Question 4

more depression, ____

Answer 4

greater % cardiac death after MI in shorter time

~30% within 5 yrs

Question 5

depression also predicts adverse outcome in ___

Answer 5

heart failure patients

incr risk of death
incr risk of re-hospitalization

Question 6

depression predicts ___ in patient health status

Answer 6

decline in patient health status in heart failure

more symptom burden, physical limitation, QOL

Question 7

mechanism of impact of depression

Answer 7

1) autonomic dysfunction
(XS sympathetic)

2) elev cortisol (decr inhib feedback, high catecholamine)
3) platelet activ
4) endothelial dysfunction (high symp tone, decr HR variability)
5) inflammation (high cytokines, platelet activ)

Question 8

role of depression in CV disease outline

Answer 8

1) defective serotonin signal
2) dysfunction in amygdala
3) autonomic dysfunction and high cortisol
4) incr catecholamine, inflamm marker
5) endothelial dysfunction/platelet activ

Question 9

depressed patients are 2-4x less likely to (4)

Answer 9

1) adhere to meds
2) quit smoking/change diet
3) self management
4) receive recommended testing/follow-up

Question 10

effects of treating depression on physiology

Answer 10

1) decr platelet activ
2) improve HR variability
3) decr inflamm markers
4) normalized brain serotonin turnover

Question 11

different strategies of treating depression

Answer 11

1) SADHART = sertaline improve sx and QOL but no effect on CV events
2) MOODCARE = telehealth effective
3) collaborative care (both meds and psychoterapy)- 48% lower risk of CVD event in 5 yrs

Question 12

questions to screen CVD patients for depression?

Answer 12

1) In the past month, have you often been bothered by feeling down, depressed, or hopeless?
2) In the past month, have you often been bothered by having little interest or pleasure in doing things?

Question 13

first line treatments for depression

Answer 13

1) SSRI
2) bupropion (Wellbutrin)
3) exercise/cognitive behavior/cardiac rehab

Question 14

treatment must be coupled with what in treating depression

Answer 14

1) patient education about treatment expectations
2) structured follow-up
3) dose/med adjustment
4) mental health

Question 15

beta blockers ___ cause depression

Answer 15

DO NOT

Question 16

what else is corollary with depression and CVD?

Answer 16

anxiety/PTSD with CVD

Question 17

role of amygdala in depressed patients

Answer 17

elevated brain serotonin turnover

stress response

Question 18

Collaborative care approach

important in treating depression

Answer 18

1) Focus on team approach
2) Engage patient

3) step-wise incr in approach
to therapy

Question 19

Things that have been improved with depression treatment

Answer 19

depression
quality of life
physiology

Question 20

things we don’t now after treatment with depression

Answer 20

adherence
costs of care
CV events