Patients with heart disease should be screened and treated for depression because it can adversely affect their health outlook and quality of life, according to a new report by the American Heart Association.

The recommendation could potentially affect millions of people - heart disease is the top cause of death in the United States with more than 80 million people suffering some form of it.

"The important message is to identify people and offer them treatment," said Erika Froelicher, a professor at the UCSF School of Nursing and Medicine and a leader in writing the scientific statement.

In the report released Monday, researchers reviewed dozens of studies and found that depression is three times more common among people who have had a heart attack compared with the general population. Moreover, young women appeared to have an even higher risk of depression after a heart attack.

Additionally, the American Heart Association said that people who were hospitalized for such conditions as unstable angina, angioplasty, bypass surgery or valve surgery suffered from depression at rates similar to those who'd had an outright heart attack.

Froelicher said that cardiac patients should be asked two key questions: "Have you recently felt little interest or pleasure in doing things?" and "Are you feeling down, depressed or hopeless?"

If patients answer yes, they should be evaluated further.

The screening should be routinely done in such medical settings as hospitals, rehabilitation centers and doctors' offices. Treatment could range from medication to exercise to cognitive behavioral therapy.

Depression can also lead to heart attacks in the first place, Froelicher noted. "People with depression might not exercise or eat well, or they might smoke," she said.

South Bay heart patient Robert Lacey says he learned in hindsight that he'd experienced a mild form of depression following quadruple bypass surgery nearly 18 years ago. Ordered to take it easy for three months, he said he'd planned to do many projects at his home tool shop.

"But everything I touched turned to garbage," said Lacey, now 70, a retired machinist living in Los Gatos. "I couldn't concentrate. For awhile, until I got through it, my mind just wasn't set right. Some days I didn't want to get out of bed. That's not me - I like getting out of bed and moving."

As coordinator of a Mended Hearts Inc. chapter, which offers support to heart patients, Lacey visits patients weekly at several hospitals. If he senses that they might be experiencing depression, he alerts their doctor or spouse.

"I try my best to take the negativity out of what is going on," he said. "The reality is we get a reprieve every single day."

Elizabeth Fernandez