Differences in the Prevalence of Screen-Detected Depression After Acute Coronary Syndrome Between Health Systems in the USA: Findings from CODIACS-QoL Randomized Controlled Trial.
Differences in the Prevalence of Screen-Detected Depression After Acute Coronary Syndrome Between Health Systems in the USA: Findings from CODIACS-QoL Randomized Controlled Trial.
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美国卫生系统之间通过屏幕检测到的急性冠脉综合征后抑郁症患病率的差异：CODIACS-QoL 随机对照试验的结果。
DOI：
10.1007/s11606-021-07049-0
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发表时间：
2022
影响因子：
5.7
通讯作者：
Kronish,IanM
中科院分区：
文献类型：
--
作者：
Moise,Nathalie;Davidson,KarinaW;Clarke,GregoryN;Dolor,RowenaJ;Margolis,KarenL;Kronish,IanM
研究背景：在急性冠脉综合征（ACS）后，每5个人中就有1个人的抑郁症状加重，增加了心血管事件复发和死亡的风险。1多项研究建议对ACS后患者进行抑郁筛查和综合治疗。1虽然抑郁率因患者特征而异，但对健康系统水平上抑郁筛查阳性率的差异知之甚少。我们试图确定在调整患者特征后，ACS后抑郁检测率是否因健康系统而异。一项多健康系统3组随机临床试验，比较了有和没有加强抑郁症护理的抑郁症筛查与没有抑郁症筛查。2我们在2013年11月至2017年4月期间从4个地理位置不同的卫生系统招募了ACS后患者：HealthPartners（明尼苏达州明尼阿波利斯）;杜克大学卫生系统（达勒姆，NC）; Kaiser Permanente Northwest（波特兰，OR）;和纽约长老会医院/哥伦比亚（纽约，NY）。我们根据急性心肌梗死和不稳定型心绞痛的标准化国际疾病分类出院代码，筛选了符合条件的21岁以上讲英语或西班牙语且在入组后2-12个月内有ACS记录的患者的电子健康记录。我们排除了既往或当前抑郁症诊断或治疗的个体;预期寿命< 1年;既往或当前双相情感障碍，自杀风险或精神病史;当前药物滥用;痴呆;当前妊娠;或需要频繁住院的严重慢性疾病。
BACKGROUNDOne in 5 individuals has elevated depressive symptoms following acute coronary syndromes (ACS), increasing the risk of recurrent cardiovascular events and mortality. 1 Multiple advisories recommend depression screening and comprehensive treatment in post-ACS patients. 1 While depression rates vary by patient characteristics, little is known about differences in depression screen-positive rates at the health system level.OBJECTIVEWe sought to determine whether post-ACS depression detection rates differ by healthcare system after adjusting for patient characteristics.METHODSWe used baseline visit data from the CODIACS-QoL, a multi-health system 3-group randomized clinical trial of depression screening with and without enhanced depression care versus no depression screening. 2 We recruited post-ACS patients between November 2013 and April 2017 from 4 geographically diverse health systems: HealthPartners (Minneapolis, MN); Duke University Health System (Durham, NC); Kaiser Permanente Northwest (Portland, OR); and New York-Presbyterian Hospital/Columbia (New York, NY). We screened electronic health records for eligible English-or Spanish-speaking individuals≥ 21 years old and with documented ACS within 2–12 months of enrollment based on standardized International Classification of Diseases discharge codes for acute myocardial infarction and unstable angina. We excluded individuals with prior or current depression diagnosis or treatment; life expectancy< 1 year; prior or current history of bipolar disorder, suicidal risk, or psychosis; current substance abuse; dementia; current pregnancy; or severe chronic illness requiring frequent hospitalizations.