Close to the heart: why asking cardiac patients about mental health matters

David Lim, MD, PhDChief Medical Officer

Healthcare | Mar 5, 2018

It’s a familiar scenario: a patient comes in who is recovering from a heart attack or bypass surgery, or is living with a chronic coronary disease. As their primary care physician, you talk with them about how to manage their condition — good nutrition, physical activity, tracking blood pressure and heart rate. But have you asked about their mental health?

A patient who has experienced a heart attack is three times more likely to develop depression as compared to the general population. That’s certainly an unwelcome concern when a patient is already dealing with the stress of recovery — but the fact is that 20 percent of myocardial infarction patients experience symptoms of depression.

The potential harm stemming from this comorbidity extends beyond interfering with someone’s quality of life. Depression can lead to poor medical adherence and contribute to negative outcomes: endothelial dysfunction, platelet abnormalities, inflammation, and autonomic nervous system dysfunction have been linked to depression and subsequent negative cardiac outcomes.

These poor health outcomes lead to increased healthcare utilization: patients with depression after a heart attack spend 24% more days hospitalized than those without depression after a heart attack. Furthermore, patients with depression are more likely to suffer from another attack — at least double the risk in the two years after the first event.

This is unsurprising given that depression interferes with patients’ adherence to treatment plans, healthy diet and exercise regimens, and rehabilitation programs. It is no small problem — there is evidence that depression can double mortality risk in the decade after someone has a heart attack.

So what can you do?

Caring for someone who is having difficulty sticking to their treatment plan can present challenges and frustrations for both you and your patient. Fortunately, you can mitigate those challenges by routinely screening your cardiac patients for depression — over the course of long-term care, not just in the few months after the initial event.

The PHQ-9 has been found to be a quick and effective way to screen cardiac patients for depression, as compared to other assessment tools. This is a powerful tool in your arsenal to help patients avoid another hospitalization.  A 2013 study found each additional point on the PHQ-9 corresponded to a 9% increase in likelihood for readmission in the subsequent six months after an initial cardiac event.

Once you identify that a patient has underlying depression symptoms, you can connect them to the right mental health resources and services. It can make all the difference in getting someone back on track with their health and quality of life. We’ve seen it happen in our work at Quartet with people like Dave, a cardiac patient in Pittsburgh.

Dave had a history of heart disease and eventually had triple bypass surgery in addition to aortic aneurysm repair. After surgery, he was unable to do the work he loved — building and fixing clocks. He began to worry about his finances and the potential of losing his business. He slipped into a deep depression that went untreated until Quartet, using our predictive data algorithms, identified that Dave likely had an underlying mental health condition. We worked with Dave’s primary care provider to connect him to a local mental health counselor. We were able to facilitate collaboration to treat his total health and help him get back to his normal life.

You likely see hundreds of patients like Dave — take five minutes to screen your cardiac patients for depression. You can help them avoid the physical and emotional toll of another cardiac event, and may even save their life.

Learn more about how Quartet can help you connect patients with mental health support >>

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