The Bypassing the Blues treatment protocol: stepped collaborative care for treating post-CABG depression

Abstract

Objective: To present the design of the Bypassing the Blues (BtB) study to examine the impact of a collaborative care strategy for treating depression among patients with cardiac disease. Coronary artery bypass graft (CABG) surgery is one of the most common and costly medical procedures performed in the US. Up to half of post-CABG patients report depressive symptoms, and they are more likely to experience poorer health-related quality of life (HRQoL), worse functional status, continued chest pains, and higher risk of cardiovascular morbidity independent of cardiac status, medical comorbidity, and the extent of bypass surgery.

Methods: BtB was designed to enroll 450 post-CABG patients from eight Pittsburgh-area hospitals including: (1) 300 patients who expressed mood symptoms preceding discharge and at 2 weeks post hospitalization (Patient Health Questionnaire (PHQ-9) >or=10); and (2) 150 patients who served as nondepressed controls (PHQ-9 <5). Depressed patients were randomized to either an 8-month course of nurse-delivered telephone-based collaborative care supervised by a psychiatrist and primary care expert, or to their physicians' "usual care." The primary hypothesis will test whether the intervention can produce an effect size of >or=0.5 improvement in HRQoL at 8 months post CABG, as measured by the SF-36 Mental Component Summary score. Secondary hypotheses will examine the impact of our intervention on mood symptoms, cardiovascular morbidity, employment, health services utilization, and treatment costs.

Results: Not applicable.

Conclusions: This effectiveness trial will provide crucial information on the impact of a widely generalizable evidence-based collaborative care strategy for treating depressed patients with cardiac disease.

Trial registration: ClinicalTrials.gov NCT00091962.

Figure 1

Bypassing the Blues study design. PHQ = Patient Health Questionnaire.

Figure 2

Sample overview screenshot portraying a particular intervention patient’s progress with our treatment algorithm. Note serial Patient Health Questionnaire (PHQ-9) scores, pharmacotherapy usage, workbook lesson plans, and specialty referral.

Figure 3

Example of a structured form letter report sent to a patient’s primary care physician to keep them informed of their patients’ progress. The patient and nurse care manager’s names have been removed to protect their identities. PHQ = Patient Health Questionnaire.