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编译服务: 心血管疾病防治 编译者: 张燕舞 编译时间: May 22, 2018 浏 览 量: 1

急性冠脉综合征后,患者抑郁症风险增加。 在对6项前瞻性观察研究(超过1700名患者)的系统回顾中,急性冠状动脉综合征患者单相性重度抑郁症筛查的诊断准确性(表1)与令人满意,并与一般人群中观察到的相当。建议在急性冠状动脉综合征患者中筛查抑郁症,并在筛查中实施服务以确保随访的诊断和治疗。

Background Patients who have had an acute coronary syndrome (ACS) event have an increased risk for depression.

Purpose To evaluate the diagnostic accuracy of depression screening instruments and to compare safety and effectiveness of depression treatments in adults within 3 months of an ACS event.

Data Sources MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews from January 2003 to August 2017, and a manual search of citations from key primary and review articles.

Study Selection English-language studies of post-ACS patients that evaluated the diagnostic accuracy of depression screening tools or compared the safety and effectiveness of a broad range of pharmacologic and nonpharmacologic depression treatments.

Data Extraction 2 investigators independently screened each article for inclusion; abstracted the data; and rated the quality, applicability, and strength of evidence.

Data Synthesis Evidence from 6 of the 10 included studies showed that a range of depression screening instruments produces acceptable levels of diagnostic sensitivity, specificity, and negative predictive values (70% to 100%) but low positive predictive values (below 50%). The Beck Depression Inventory-II was the most studied tool. A large study found that a combination of cognitive behavioral therapy (CBT) and antidepressant medication improved depression symptoms, mental health-related function, and overall life satisfaction more than usual care.

Limitation Few studies, no evaluation of the influence of screening on clinical outcomes, and no studies addressing several clinical interventions of interest.

Conclusion Depression screening instruments produce diagnostic accuracy metrics that are similar in post-ACS patients and other clinical populations. Depression interventions have an uncertain effect on cardiovascular outcomes, but CBT combined with antidepressant medication produces modest improvement in psychosocial outcomes.

Primary Funding Source Agency for Healthcare Research and Quality (PROSPERO: CRD42016047032).

  
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