title: Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association.
abstract: BACKGROUND
  Although prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome.
  
  
  RESULTS
  Writing group members were approved by the American Heart Association's Scientific Statement and Manuscript Oversight Committees. A systematic literature review on depression and adverse medical outcomes after acute coronary syndrome was conducted that included all-cause mortality, cardiac mortality, and composite outcomes for mortality and nonfatal events. The review assessed the strength, consistency, independence, and generalizability of the published studies. A total of 53 individual studies (32 reported on associations with all-cause mortality, 12 on cardiac mortality, and 22 on composite outcomes) and 4 meta-analyses met inclusion criteria. There was heterogeneity across studies in terms of the demographic composition of study samples, definition and measurement of depression, length of follow-up, and covariates included in the multivariable models. Despite limitations in some individual studies, our review identified generally consistent associations between depression and adverse outcomes.
  
  
  CONCLUSIONS
  Despite the heterogeneity of published studies included in this review, the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Lichtman
authors.forename: Erika S
authors.initials: ES
authors.lastname: Froelicher
authors.forename: James A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: Robert M
authors.initials: RM
authors.lastname: Carney
authors.forename: Lynn V
authors.initials: LV
authors.lastname: Doering
authors.forename: Nancy
authors.initials: N
authors.lastname: Frasure-Smith
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Freedland
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
authors.forename: Erica C
authors.initials: EC
authors.lastname: Leifheit-Limson
authors.forename: David S
authors.initials: DS
authors.lastname: Sheps
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: Lawson
authors.initials: L
authors.lastname: Wulsin
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality*; D000572:American Heart Association; D002309:Cardiology / Q000592:standards*; D003863:Depression / Q000401:mortality*; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012307:Risk Factors; D014481:United States
keywords: AHA Scientific Statements; acute coronary syndrome; coronary heart disease; depression; risk factors