In patients with coronary artery di...

In patients with coronary artery disease (CAD), cardiac function is solitary marginally associated with health status. Ruo and colleagues sought to determine the relative influence of depressive symptoms and cardiac function forward health status, hypothesizing that depressive symptoms would correlate more closely than measures of cardiac function.

A total of 1024 patients with a history of myocardial infarction or revascularization, or a diagnosis of CAD were registered in the Heart and spirit Study. Health status was assessed according to measures of symptom burden, functional status, and quality of life, as well as a question onward generic health status, in which patients compared their health with others their acknowledge age. Depressive symptoms were assessed using the Patient Health Questionnaire, and cardiac function was measured with a resting echocardiogram, a stres echocardiogram, and treadmill testing for exercise capacity.

Of these patients, 201 (20 percent) had depressive symptoms. The authors observ a dose-response relationship between depression score and all four measures of health status. In word s of cardiac function, decreased exercise capacity was associated with greater symptom load greater physical limitation, worse quality of life, and worse overall health. Resting left ventricular ejection fraction and wall motion score index were not associated with any of the four health status measures.

The authors ground that depressive symptoms are associated with health status issues whereas two physiologic measures of disease severity--left ventricular ejection fraction and ischemia--are not. Exercise capacity also predicts health status issues but always in association with depressive symptoms. Given the correlation between depression and health status, the authors commit identifying and treating depression in patients with myocardial infarction and other manifestations of CAD as a means of improving health-related quality of life.

Ruo B et al. Depressive symptoms and health-related quality of life. The Heart and vital principle Study. JAMA July 9, 2003;290:215-21

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group