Identify patients who also have depression and initiate therapy or referral for therapy.

Depression is prevalent in patients with IHD and is independently associated with a worse prognosis. There is efficacious treatment available for depression. It is not known whether the treatment of depression improves CV outcomes, though it is known that such treatment improves compliance with efficacious therapies. There are several available tools to screen for depression in the primary care setting. See the VHA/DoD Clinical Practice Guideline for the Management of Major Depressive Disorder in Adults for a discussion of depression screening. As an example, the PRIME MD efficiently screens for criteria-based DSM IV diagnosis of depressive disorders (Spitzer et al., 1994).