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Randomized Controlled Trial
. 2010 Apr 12;170(7):600-8.
doi: 10.1001/archinternmed.2010.29.

Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial

Karina W Davidson  1 , Nina Rieckmann, Lynn Clemow, Joseph E Schwartz, Daichi Shimbo, Vivian Medina, Gabrielle Albanese, Ian Kronish, Mark Hegel, Matthew M Burg
Affiliations
Randomized Controlled Trial

Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial

Karina W Davidson et al. Arch Intern Med. .

Abstract

Background: Depressive symptoms are an established predictor of mortality and major adverse cardiac events (defined as nonfatal myocardial infarction or hospitalization for unstable angina or urgent/emergency revascularizations) in patients with acute coronary syndrome (ACS). This study was conducted to determine the acceptability and efficacy of enhanced depression treatment in patients with ACS.

Methods: A 3-month observation period to identify patients with ACS and persistent depressive symptoms was followed by a 6-month randomized controlled trial. From January 1, 2005, through February 29, 2008, 237 patients with ACS from 5 hospitals were enrolled, including 157 persistently depressed patients randomized to intervention (initial patient preference for problem-solving therapy and/or pharmacotherapy, then a stepped-care approach; 80 patients) or usual care (77 patients) and 80 nondepressed patients who underwent observational evaluation. The primary outcome was patient satisfaction with depression care. Secondary outcomes were depressive symptom changes (assessed with the Beck Depression Inventory), major adverse cardiac events, and death.

Results: At the end of the trial, the proportion of patients who were satisfied with their depression care was higher in the intervention group (54% of 80) than in the usual care group (19% of 77) (odds ratio, 5.4; 95% confidence interval [CI], 2.2-12.9 [P < .001]). The Beck Depression Inventory score decreased significantly more (t(155) = 2.85 [P = .005]) for intervention patients (change, -5.7; 95% CI, -7.6 to -3.8; df = 155) than for usual care patients (change, -1.9; 95% CI, -3.8 to -0.1; df = 155); the depression effect size was 0.59 of the standard deviation. At the end of the trial, 3 intervention patients and 10 usual care patients had experienced major adverse cardiac events (4% and 13%, respectively; log-rank test, chi(2)(1) = 3.93 [P = .047]), as well as 5 nondepressed patients (6%) (for the intervention vs nondepressed cohort, chi(2)(1) = 0.48 [P = .49]).

Conclusion: Enhanced depression care for patients with ACS was associated with greater satisfaction, a greater reduction in depressive symptoms, and a promising improvement in prognosis.

Trial registration: clinicaltrials.gov Identifier: NCT00158054.

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Figures

Figure 1
Figure 1
Patient flowchart. BDI indicates Beck Depression Inventory.
Figure 2
Figure 2
Kaplan-Meier survival curves for major adverse cardiac events in the Coronary Psychosocial Evaluation Studies for randomized patients and the nondepressed cohort. *The number at risk at 9 months includes those who were evaluated during the ninth month.
See this image and copyright information in PMC

Comment in

References

    1. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006;27(23):2763–2774. - PubMed
    1. Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med. 2004;66(6):802–813. - PubMed
    1. Penninx BW, Beekman AT, Honig A, et al. Depression and cardiac mortality: results from a community-based longitudinal study. Arch Gen Psychiatry. 2001;58(3):221–227. - PubMed
    1. Frasure-Smith N, Lespérance F. Reflections on depression as a cardiac risk factor. Psychosom Med. 2005;67(suppl 1):S19–S25. - PubMed
    1. Rosengren A, Hawken S, Ounpuu S, et al. INTERHEART Investigators Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):953–962. - PubMed

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