Beyond the blues : the need for integrated care pathways

Coronary heart disease (CHD) is a leading cause of morbidity and mortality and has significant human and economic consequences. Many people who survive have significant psychological distress, and diminished quality of life and failure to return to work or resume normal family and social roles are not uncommon. Increased attention has been focused on the role of depression, both as a predictor and a consequence of CHD,1–5 especially myocardial infarction.6–8 When depression is linked with CHD the outcome inevitably increases disease burden.9 The importance of early detection and early referral for treatment before hospital discharge may be an optimum moment along the care pathway.