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Randomized Controlled Trial
. 2014 Oct;127(10):1012-6.
doi: 10.1016/j.amjmed.2014.05.004. Epub 2014 May 14.

Long-term outcomes of enhanced depression treatment in patients with acute coronary syndromes

Siqin Ye  1 , Jonathan A Shaffer  2 , Nina Rieckmann  3 , Joseph E Schwartz  4 , Ian M Kronish  2 , Joseph A Ladapo  5 , William Whang  2 , Matthew M Burg  6 , Karina W Davidson  2
Affiliations
Randomized Controlled Trial

Long-term outcomes of enhanced depression treatment in patients with acute coronary syndromes

Siqin Ye et al. Am J Med. 2014 Oct.

Abstract

Background: The Coronary Psychosocial Evaluation Studies trial demonstrated promising results for enhanced depression treatment to reduce cardiovascular risk of patients with acute coronary syndrome and comorbid depression, but the long-term effectiveness of this intervention is unclear.

Methods: A total of 157 participants with persistent depression after hospitalization for acute coronary syndromes were enrolled in the Coronary Psychosocial Evaluation Studies trial. A total of 80 participants were allocated to 6 months of enhanced depression treatment, and 77 participants were allocated to usual care. We report on an additional 12 months of observational follow-up for the composite outcome of death or first hospitalization for myocardial infarction or unstable angina.

Results: Although the intervention was previously shown to have favorable cardiovascular effects during the treatment period, we observed a significant time-by-treatment group interaction during extended follow-up (P = .008). Specifically, during the 6-month treatment period, death or hospitalization for myocardial infarction/unstable angina occurred in 3 participants (4%) in the treatment group compared with 11 participants (14%) in the usual care group (hazard ratio, 0.25; 95% confidence interval, 0.07-0.90; P = .03). In contrast, during 12 months of additional observational follow-up, 11 participants (14%) in the treatment group experienced the composite outcome of death or hospitalization for myocardial infarction/unstable angina compared with 3 participants (4%) in the usual care group (hazard ratio, 2.91; 95% confidence interval, 0.80-10.56; P = .10).

Conclusions: Enhanced depression treatment was associated with a reduced risk of death or hospitalization for myocardial infarction/unstable angina during active treatment, but this effect did not persist after treatment ceased. Future research is needed to confirm our findings and to determine the optimal duration of depression treatment in patients with depression after acute coronary syndromes.

Trial registration: ClinicalTrials.gov NCT00158054.

Keywords: Acute coronary syndrome; Depression.

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Figures

Figure 1
Figure 1
Title: Patient flowchart. BDI indicates Beck Depression Inventory.
Figure 2
Figure 2
Title: Survival free from death or hospitalization for myocardial infarction or unstable angina, by treatment assignment.
See this image and copyright information in PMC

References

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