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CLINICAL STATEMENTS AND GUIDELINES

August 29, 2023 Circulation. 2023;148:e9–e119. DOI: 10.1161/CIR.0000000000001168

Virani et al 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Chronic Coronary Disease Guideline

(eg, Patient Health Questionnaire-2, Generalized Anxiety Disorder Questionnaire-2) or brief questions on psychological health (eg, positive affect) are available for use in clinical settings (Tables 7 and 8).7,31,32 It is reasonable to refer patients with positive screening for in-depth assessment by qualified mental health professionals or to accessible resources to promote mental health care.33

2 Despite the preponderance of data show-

ing the association of depression with adverse cardiovascular outcomes, treatment with antidepressants (14%) and psychotherapies (<10%) is low in patients after MI.34 Studies including patients after ACS with depression found no definitive benefit of antidepressants on long-term cardiovascular outcomes.15,17,35–37 However, the EsDEPACS (Escitalopram in Depressive Patients with Acute Coronary Artery Syndrome) study showed lower MACE after a median 8.1 years follow-up in patients with recent ACS treated with escitalopram compared with placebo (40.9% versus 53.6%; hazard ratio, 0.69 [95% CI, 0.49-0.96]).5 The TRIUMPH (Lifestyle Interventions in Treatment-Resistant Hypertension) trial found a higher 1-year mortality rate among patients with untreated depression compared with patients with treated depression (rates similar to those without depression).6 In a recent systematic review and meta-analysis, combination pharmacologic and psychotherapy, exercise, and antidepressants improved depressive symptoms among patients with CCD but had no mortality benefit.38 CR (Section 4.2.10) improves depression, cardiovascular outcomes, and mortality

Table 7.  Suggested Screening Questions to Assess Psychological Health Well-being parameter Question Health-related optimism How do you think things will go with your health moving forward? Positive affect How often do you experience pleasure or happiness in your life? Gratitude Do you ever feel grateful about your health? Do you ever feel grateful about other things in your life? Data derived from Levine GN et al.7,46 Reprinted with permission from Levine GN et al. Copyright 2021 American Heart Association, Inc.

Table 8.  Behavioral Resources for Smoking Cessation Resource Description Telephone-based: Quitline English: 1-800-QUIT-NOW (1-800-784-8669) Spanish: 1-855-DÉJELO-YA (1-855-335-3569) Mandarin and Cantonese: 1-800-838-8917 Korean: 1-800-556-5564 Vietnamese: 1-800-778-8440 Counseling by telephone from a trained tobacco coach who offers support via a series of scheduled telephone calls before and after a smoker’s quit date.

Patients can self-refer to the Quitline, or clinicians can refer patients, with their consent, proactively. Quitline services vary by state, can include text messaging and web coaching support, and may provide free samples of nicotine replacement therapy. State-by-state information about Quitline services is available at https://www.cdc.gov/tobacco/patient-care/ quitlines-other/index.html

Web-based: American Lung Association Freedom From Smoking https://www.lung.org/ quit-smoking/join-freedom-from-smoking Created by the American Lung Association to support smoking cessation in persons who want to quit. The program also provides information about nicotine replacement therapy and pharmacotherapy.

Multiple modes of support available to patients, including group clinics, a telephone-based “Lung HelpLine,” a self-help guide, and a web-based interactive customized program. Interactive program available for computer, tablet, or smartphone interface.

Web-based: National Cancer Institute English: Smokefree.gov Spanish: https://espanol.smokefree.gov/ Spanish Supported by the US Department of Health and Human Services and National Institutes of Health, created by the National Cancer Institute.

Website contains information about quitting and resources for quitting and allows users to create a personalized quit plan. Specific websites are also available for women, teens, Veterans, and those >60 y of age. Programs available through the website include: SmokefreeTXT (text messaging program), QuitGuide, and quitSTART (mobile phone apps).

Web-based: Asian Smokers’ Quitline Mandarin, Cantonese, Korean, and Vietnamese Speakers https://www.asiansmokersquitline. org/ Operated by the Moores Cancer Center at the University of California, San Diego, funded by a grant from the US Centers for Disease Control and Prevention.

Created to support tobacco cessation for persons who speak Mandarin, Cantonese, Korean, and Vietnamese across the United States. Some participants may be eligible for a 2-wk starter kit of nicotine patches. Telephone counseling developed to deliver a quit plan and support quitting, and printed self-help materials sent to participants.

Web-based: BecomeAnEX Available in English and Spanish https://www.becomeanex.org Created by the Truth Initiative, a nonprofit public education in partnership with the Mayo Clinic Nicotine Dependence Center.

Website with information about cessation of smoking, vaping, or use of smokeless tobacco, with resources to build an individualized quit plan. Includes support from experts and an online community, and a text message–based program for quitting vaping focused on teens and young adults, “This is Quitting.” An employer-based program, the EX Program, is also available through the Truth Initiative.

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