Low Priority for Feeling Low

Heart attack patients with depression given lower priority in emergency rooms

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Heart attack patients are less likely to receive priority care in emergency departments if they have a history of depression, according to a study by researchers at the Institute of Clinical Evaluative Sciences.

Past studies have shown that heart attack patients with a history of depression do not fare as well as those without depression. Until now, no study has looked at emergency department care as a contributing factor to this disparity.

Having a history of depression was linked to a greater risk of receiving a low priority emergency department triage score, as well as delays in diagnostic tests and definitive care, write the authors. Surprisingly, other factors that are usually associated with an increased risk of heart attack - such as diabetes, smoking, and high blood pressure - did not affect patients' triage score. In this study, only depression had an effect on the score.

Dr. Clare Atzema, from the Institute for Clinical Evaluative Sciences, and her co-authors suggest that emergency department staff may give low priority to those with a history of depression because they think that patients' symptoms are the result of anxiety, as opposed to a real heart attack.

In a study of 6,874 heart attack patients admitted to various hospitals in Ontario, 680 patients had a history of depression. Atzema found that 39 percent of heart attack patients with depression given a low priority triage score (the score used to determine the priority of patients' treatments based on the severity of their condition) in hospital emergency departments. In comparison, a little less than 33 percent of non-depressed heart attack patients were given a low priority score.

Upon going to an emergency department, few patients with symptoms of heart attack (less than 10 percent) actually have had a heart attack. As such, emergency department staff actively search for other potential sources of patients' symptoms.

The authors conclude that the mistakes in patient prioritization are not the result of intentional discrimination by emergency room staff, but rather the result of staff's unawareness of the association between depression and coronary artery disease. These findings suggest that information must be circulated more effectively to emergency room staff.

Both heart attacks and depression are extremely common in the United States. Over 14 million Americans are affected by major depressive disorder. Every year, approximately 1.5 million Americans suffer a heart attack, causing about 500,000 deaths.

Depression impacts an estimated 15 million adults in the United States. Depression is a state of prolonged low mood and aversion to activity. A person's thoughts, behavior, feelings and physical well-being are affected and may include feelings of sadness, anxiety, emptiness, hopelessness, worthlessness, guilt, irritability, or restlessness. The primary treatments for major depression are psychological counseling and medications. Medication therapies include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs). SSRIs include: fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft®), citalopram (Celexa®) and escitalopram (Lexapro®). SNRIs include: duloxetine (Cymbalta®), venlafaxine (Effexor®) and desvenlafaxine (Pristiq®). Bupropion (Wellbutrin) is an NDRI. Atypical antidepressants include trazodone (Desyrel®) and mirtazapine (Remeron®). Each medication category has different side effects.

This study is published in the Canadian Medical Association Journal.

Reviewed by: 
Review Date: 
February 28, 2011
Last Updated:
March 9, 2011