Coronary heart disease and depression: Getting evidence into clinical practice

Clinical guidelines based on systematic reviews of the evidence recommend identification and treatment of patients with coronary heart disease and depression. The evidence shows that depression is an independent risk factor for heart disease, and when present after an acute coronary event, is a predictor of poor prognosis. This paper will describe our experience of getting that evidence into practice using change management based on mapping the processes of the patient's journey through the healthcare system. This allowed identification of the points in the journey where screening and intervention could take place. Cardiac rehabilitation is the intervention point for acute presentation, and primary care has the role in long term follow up of risk factors including depression. Overall, comorbid depression is best managed within a system of collaborative care based on chronic disease management principles.