A study determines that people with heart disease have not been diagnosed with depression but are at high-risk for it are more likely to report worse health care experiences and use emergency room services more often than those diagnosed with depression. Heart attack patients diagnosed with depression are more likely to be hospitalized, use emergency rooms and annually spend more on healthcare than heart attack patients without depression.

According to preliminary research presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2018, a premier global exchange of the latest advances in quality of care and outcomes research in cardiovascular disease and stroke for researchers, healthcare professionals and policymakers.

Depression, even when undiagnosed, can have many negative effects on cardiovascular patients, including poor health care experiences, more use of healthcare resources and higher health costs. About one-fifth of cardiovascular disease patients suffer from depression.

They evaluated the patient experience, healthcare expenditure and resource use in a large population of adult cardiovascular disease patients, dividing them into two groups: those who had been diagnosed with depression and those who had not been diagnosed with depression.

Based on responses from a health questionnaire, patients who had not been diagnosed with depression were divided into high- and low-risk groups for depression. When researchers compared high- and low-risk groups of cardiovascular patients without depression, they found:

1. Those at high risk for depression spent more on overall and out-of-pocket health care expenditures yearly when compared with patients in the low-risk group.

2. High-risk patients with depression were more than two times more likely to be hospitalized and used the emergency room than those at low risk.

3. High-risk patients were more than five times more likely to have a poor self-perceived health status, and almost four times more likely to be dissatisfied with their healthcare.

4. Patients at high risk for depression had notably worse healthcare-related quality of life.

Researchers found that heart attack patients diagnosed with depression were 54% more likely to be hospitalized and 43% more likely to have emergency room visits, compared to those not diagnosed with depression. Furthermore, heart attack patients with depression spent an estimated $4,381 more, annually on healthcare expenses, compared with those without depression.

"Depression and heart attack often coexist, which has been associated with worse health experiences for these patients," he said. "As a quality improvement measure to increase healthcare efficiency, we recommend more aggressive depression screening at follow-up visits for heart attack patients."

In a separate study by a different group of researchers, stroke patients diagnosed with depression before having a stroke were more likely than those without depression to report functional declines and worse stroke impact on health and quality of life months after their stroke. Researchers studied more than 1,600 stroke patients with similar stroke severity and functional status when discharged from the hospital. 

The Author found those diagnosed with depression before having a stroke were 56% more likely than those without depression to report functional declines and a greater negative stroke-related impact on health and life. The researchers call for strategies to more effectively manage existing depression among stroke patients to improve patients' health and quality of life post stroke.