title: Depression screening in patients with coronary heart disease: a critical evaluation of the AHA guidelines.
abstract: OBJECTIVE
  We lack evidence that routine screening for depression in patients with coronary heart disease (CHD) improves patient outcome. This lack has challenged the advisory issued by the American Heart Association (AHA) to routinely screen for depression in CHD patients. We assess the AHA advisory in the context of well-established criteria of screening for diseases.
  
  
  METHODS
  Using principles and criteria for screening developed by the World Health Organization and the United Kingdom National Screening Committee, we generated criteria pertinent to screening for depression in CHD patients. To find publications relevant to these criteria and clinical setting, we performed a broadly based literature search on "depression and CHD," supplemented by more focused literature searches.
  
  
  RESULTS
  Evidence for an association between depression and CHD is strong. Despite this, the AHA advisory has several limitations. It did not account for the complexity of the association between depression and CHD. It acknowledged there was no evidence that screening for depression leads to improved outcomes in cardiovascular populations but still recommended routine screening without providing an alternative evidence-based explanation. It ignored the paucity of literature about the safety and cost-effectiveness of routine screening for depression in CHD and failed to define the nature and extent of resources needed to implement such a program effectively.
  
  
  CONCLUSIONS
  We conclude that the AHA advisory is premature. We must first demonstrate the efficacy, safety, and cost-effectiveness of screening and define the resources necessary for its implementation and monitoring. Meanwhile, organizations representing cardiologists, psychiatrists, and general practitioners must coordinate efforts to manage depression and CHD through collaborative care, and work with the policy makers to develop the necessary infrastructure and services delivery system needed to optimize the outcome of depressed and at-risk-for-depression patients suffering from CHD.
authors.affiliation: Department of Psychiatry, Memorial University of Newfoundland, St. John's, Newfoundland, Canada. mehrul_hasnain@yahoo.com
authors.forename: Mehrul
authors.initials: M
authors.lastname: Hasnain
authors.forename: W Victor R
authors.initials: WV
authors.lastname: Vieweg
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Lesnefsky
authors.forename: Ananda K
authors.initials: AK
authors.lastname: Pandurangi
mesh_terms: D000572:American Heart Association; D003327:Coronary Disease / Q000150:complications* / Q000523:psychology; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D008403:Mass Screening; D017410:Practice Guidelines as Topic; D014481:United States