***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Whether there is an association between depression at the time of acute myocardial infa rct ion and subsequent risk of cardiac complications and death remains controversial . Most studies of this risk factor have been limited to patients of single institutions , and this might account for the varying results . We prospect ively evaluated patients admitted to 5 tertiary care and 5 community hospitals and followed them for 1 year to measure the prevalence and prognostic impact of depressive symptoms after acute myocardial infa rct ion . METHODS Patients were recruited for the study by trained nurse interviewers who had documented acute myocardial infa rct ion within 2 - 3 days of admission . The nurses collected information from the medical records and asked study subjects to complete the  Beck Depression Inventory question naire during their stay in hospital and using a mailed question naire 30 days , 6 months and 1 year later . We obtained information on vital status for patients lost to follow-up from a central death registry . RESULTS Of the 587 study subjects , 550 ( 94 % ) completed the Beck Depression Inventory at baseline and 191 ( 35 % ) had a score of 10 or more , indicating at least mild depression . Rates of depression did not vary over the follow-up period and were similar among patients admitted to tertiary care or community hospitals . Depressed patients were more likely to undergo catheterization ( 57 % v. 47 % , 95 % confidence interval [ CI ] around the difference 0.1%-19.6 % ) and were more likely to undergo percutaneous coronary intervention ( 32 % v. 24 % , 95 % CI around the difference 0.1%-16.2 % ) within 30 days of first admission to hospital . Patients with depression on admission had higher rates of a composite of cardiac complications , including recurrent ischemia , infa rct ion or congestive heart failure during their first stay in hospital or readmission for angina , recurrent acute myocardial infa rct ion , congestive heart failure or arrhythmia ( adjusted hazard ratio 1.4 , 95 % CI 1.05 - 1.86 ) , compared with patients who were not depressed on admission . After 1 year , death rates were higher among patients who were depressed at admission ( 30 patients , 16 % ) compared with nondepressed patients ( 28 patients , 8 % ) , although the difference was not statistically significant ( hazard ratio 1.3 , 95 % CI 0.59 - 3.05 ) . INTERPRETATION Depressive symptoms are common after acute myocardial infa rct ion and are associated with a slight increase in risk of in-hospital catheterization and angiography and readmission because of cardiac complications . Death was infrequent , with no statistically significant difference between the 2 groups Background The use of cardiovascular health services is greater among patients with depressive symptoms than among patients without . However , the extent to which such associations between depressive symptoms and health service utilization are attributable to variations in comorbidity and prognostic disease severity is unknown . This paper explores the relationship between depressive symptoms , health service cardiovascular consumption , and prognosis following acute myocardial infa rct ion ( AMI ) . Methods The study design was a prospect i ve cohort study with follow-up telephone interviews of 1,941 patients 30 days following AMI discharged from 53 hospitals across Ontario , Canada between December 1999 and February , 2003 . Outcome measures were post discharge use of cardiac and non-cardiac health care services . The service utilization outcomes were adjusted for age , sex , income , comorbidity , two vali date d measures of prognosis ( cardiac functional capacity and risk adjustment severity index ) , cardiac procedures ( CABG or PTCA ) and drugs prescribed at discharge . Results Depressive symptoms were associated with a 24 % ( Adjusted RR:1.24 ; 95 % CI:1.19–1.30 , P < 0.001 ) , 9 % ( Adjusted RR:1.09 ; 95 % CI:1.02–1.16 , P = 0.007 ) and 43 % ( Adjusted RR : 1.43 ; 95 % CI:1.34–1.52 , P < 0.001 ) increase in total , cardiac , and non-cardiac hospitalization days post-AMI respectively , after adjusting for baseline patient and hospital characteristics . Depressive-associated increases in cardiac health service consumption were significantly more pronounced among patients of lower than higher cardiac risk severity . Depressive symptoms were not associated with increased mortality after adjusting for baseline patient characteristics . Conclusion Depressive symptoms are associated with significantly higher cardiac and non-cardiac health service consumption following AMI despite adjustments for comorbidity and prognostic severity . The disproportionately higher cardiac health service consumption among lower-risk AMI depressive patients may suggest that health seeking behaviors are mediated by psychosocial factors more so than by objective measures of cardiovascular risk or necessity BACKGROUND Depression predicts worse outcomes after myocardial infa rct ion ( MI ) , but whether its time course in the month following MI has prognostic importance is unknown . Our objective was to evaluate the prognostic importance of transient , new , or persistent depression on outcomes at 6 months after MI . METHODS In a prospect i ve registry of acute MI ( Prospect i ve Registry Evaluating outcomes after Myocardial Infa rct ion : Events and Recovery [ PREMIER ] ) , depressive symptoms were measured in 1873 patients with the Patient Health Question naire ( PHQ ) during hospitalization and 1 month after discharge and were classified as transient ( only at baseline ) , new ( only at 1 month ) , or persistent ( at both times ) . Outcomes at 6 months included ( 1 ) all-cause rehospitalization or mortality and ( 2 ) health status ( angina , physical limitation , and quality of life using the Seattle Angina Question naire ) . RESULTS Compared with nondepressed patients , all categories of depression were associated with higher rehospitalization or mortality rates , more frequent angina , more physical limitations , and worse quality of life . The adjusted hazard ratios for rehospitalization or mortality were 1.34 , 1.71 , and 1.42 for transient , new , and persistent depression , respectively ( all P<.05 ) . Corresponding odds ratios were 1.62 , 2.73 , and 2.64 ( all P<.01 ) for angina and 1.69 , 2.25 , and 3.27 ( all P<.05 ) for physical limitation . Depressive symptoms showed a stronger association with health status compared with traditional measures of disease severity . CONCLUSION Depressive symptoms after MI , irrespective of whether they persist , subside , or newly develop in the first month after hospitalization , are associated with worse outcomes after MI Abstract BACKGROUND : The persistence of depressive symptoms after hospitalization is a strong risk factor for mortality after acute coronary syndromes ( ACS ) . Poor adherence to secondary prevention behaviors may be a mediator of the relationship between depression and increased mortality . OBJECTIVE : To determine whether rates of adherence to risk reducing behaviors were affected by depressive status during hospitalization and 3 months later . DESIGN : Prospect i ve observational cohort study . SETTING : Three university hospitals . PARTICIPANTS : Five hundred and sixty patients were enrolled within 7 days after ACS . Of these , 492 ( 88 % ) patients completed 3-month follow-up . MEASUREMENTS : We used the Beck Depression Inventory ( BDI ) to assess depressive symptoms in the hospital and 3 months after discharge . We assessed adherence to 5 risk-reducing behaviors by patient self-report at 3 months . We used χ2 analysis to compare differences in adherence among 3 groups : persistently nondepressed ( BDI<10 at hospitalization and 3 months ) ; remittent depressed ( BDI ≥10 at hospitalization ; < 10 at 3 months ) ; and persistently depressed patients ( BDI ≥10 at hospitalization and 3 months ) . RESULTS : Compared with persistently nondepressed , persistently depressed patients reported lower rates of adherence to quitting smoking  ( adjusted odds ratio [ OR ] 0.23 , 95 % confidence interval [ 95 % CI ] 0.05 to 0.97 ) , taking medications ( adjusted OR 0.50 , 95 % CI 0.27 to 0.95 ) ,  exercising  ( adjusted OR 0.57 , 95 % CI 0.34 to 0.95 ) , and attending cardiac rehabilitation ( adjusted OR 0.5 , 95 % CI 0.27 to 0.91 ) . There were no significant differences between remittent depressed and persistently nondepressed patients . CONCLUSIONS : Persistently depressed patients were less likely to adhere to behaviors that reduce the risk of recurrent ACS . Differences in adherence to these behaviors may explain in part why depression predicts mortality after ACS Research to date indicates that the number of  coronary artery bypass graft ( CABG ) surgery patients affected by depression ( i.e. , major , minor , dysthymia ) approximates between 30 % and 40 % of all cases . A longst and ing empirical interest on psychosocial factors in  CABG surgery patients highlights an association with increased risk of morbidity in the short and longer term . Recent evidence suggests that both depression and anxiety increase the risk for mortality and morbidity after CABG surgery independent of medical factors , although the behavioral and biological mechanisms are poorly understood . Though neither depression nor anxiety seem to markedly affect neuropsychological dysfunction , depression confers a risk for incident delirium . Following a comprehensive overview of recent literature , practical advice is described for clinicians taking into consideration possible screening aids to improve recognition of anxiety and depression among  CABG surgery patients . An overview of contemporary interventions and r and omized , controlled trials are described , along with suggestions for future CABG surgery research Objective : Posttraumatic stress disorder ( PTSD ) symptoms have been reported in patients with coronary vascular disease , after the trauma of a myocardial infa rct ion ( MI ) . The effect of these symptoms on post-MI disease control has not been eluci date d. We conducted a study that sought to determine whether PTSD symptoms post-MI are associated with increased likelihood of cardiovascular readmission and with nonadherence to treatment recommendations . Methods : Patients were recruited during a visit in a cardiology clinic 6 months post-MI and were followed for 1 year . Adherence to aspirin was measured by platelet thromboxane production ( an indication of aspirin 's effect ) . Medical outcome was measured as rate of admission due to cardiovascular causes during the follow-up period .  Self-report measures of PTSD ( Impact of Event Scale ) , Depression , and Global Distress ( SCL-90-R ) were administered at enrollment . Results : Seventy-three patients were studied . Above-threshold PTSD symptom scores at enrollment , but not depression or global distress scores , were significant predictors of nonadherence to  aspirin  and of an increased likelihood of cardiovascular readmission over the course of the following year . Conclusions : PTSD symptoms predicted poor disease control in this cohort of MI survivors . The data suggest that screening MI survivors for symptoms of PTSD may be beneficial if this high-risk population is to be targeted for interventions Objective : The objective of this study was to determine if receipt of revascularization  was similar among commercially insured adults with mental disorders compared with people without mental disorders . Methods : This was a retrospective analysis of a 100 % sample of Blue Cross/Blue Shield of Iowa administrative cl aims data , 1996 to 2001 . Logistic regression was used to calculate unadjusted and adjusted odds ratios ( OR ) for receipt of angioplasty ( PTCA ) and bypass graft surgery ( CABG ) within 30 days of discharge . Results : A total of 3368 adults , aged 18 to 64 years , were hospitalized for myocardial infa rct ion ( MI ) and 40 % ( n = 1342 ) had a mental disorder . Subjects with mental disorders were more likely to be younger , female , urban residents , and to have increased cardiovascular and medical comorbidity . They were similarly likely as subjects without mental disorders to have received PTCA ( OR , 1.10 ; 95 % confidence interval [ CI ] , 0.95–1.29 ) and CABG ( OR , 0.89 ; 95 % CI , 0.71–1.11 ) in analyses adjusted for demographic and clinical characteristics . Revascularization rates did not differ by mental disorder type , with few exceptions . Conclusions : Receipt of revascularization  was similar for patients with and without mental disorders . Our results may differ from previous findings as a result of the younger population studied and increased comorbidity in people with mental disorders , which may have result ed in a contraindication for surgical intervention . Conversely , the increased burden of comorbidity could suggest that these patients should have received PTCA at higher rates because of the better prognosis associated with revascularization as compared with medical management . Prospect i ve analyses with review of clinical data and behavioral risk factors are necessary to determine why some patients with mental illness may be less likely to receive cardiac interventions . MI = myocardial infa rct ion ; CVD = cardiovascular disease ; MHD = mental health dis 
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Most studies reported increased overall and outpatient costs for patients with comorbid mental disorders .
Conclusions Comorbid mental disorders in CAD patients are associated with an increased healthcare utilization in terms of higher hospital readmission rates and increased overall and outpatient health care costs .