Collaborative care for comorbid depression and coronary heart disease: a systematic review and meta-analysis of randomised controlled trials

Abstract

Objectives: To systematically review the efficacy of collaborative care (CC) for depression in adults with coronary heart disease (CHD) and depression.

Design: Systematic review and meta-analysis.

Data sources: Electronic databases (Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, PsycINFO and CINAHL) were searched until April 2014.

Inclusion criteria: Population, depression comorbid with CHD; intervention, randomised controlled trial (RCT) of CC; comparison, either usual care, wait-list control group or no further treatment; and outcome, (primary) major adverse cardiac events (MACE), (secondary) standardised measure of depression, anxiety, quality of life (QOL) and cost-effectiveness.

Data extraction and analysis: RevMan V.5.3 was used to synthesise the data as risk ratios (RRs), ORs and standardised mean differences (SMD) with 95% CIs in random effect models.

Results: Six RCTs met the inclusion criteria and comprised 655 participants randomised to CC and 629 participants randomised to the control group (total 1284). Collaborative depression care led to a significant reduction in MACE in the short term (three trials, RR 0.54; 95% CI 0.31 to 0.95, p=0.03) that was not sustained in the longer term. Small reductions in depressive symptoms were evident in the short term (6 trials, pooled SMD -0.31; 95% CI -0.43 to -0.19, p<0.00001) and depression remission was more likely to be achieved with CC (5 trials, OR 1.77; 95% CI 1.28 to 2.44, p=0.0005). Likewise, a significant effect was observed for anxiety symptoms (SMD -0.36) and mental QOL (SMD 0.24). The timing of the intervention was a source of between-group heterogeneity for depression symptoms (between groups p=0.04, I(2)=76.5%).

Conclusions: Collaborative depression care did not lead to a sustained reduction in the primary MACE end point. Small effects were observed for depression, depression remission, anxiety and mental QOL.

Trials registration number: PROSPERO CRD42014013653.

Keywords: CARDIOLOGY; MENTAL HEALTH.

Figure 1

Flow chart of article selection (CC, collaborative care; CHD, coronary heart disease; RCT, randomised controlled trial).

Figure 2

Forest plot showing the risk ratio for MACE postintervention in collaborative care studies versus usual care or waiting list control (short and medium terms). MACE, major adverse cardiac events; IV, inverse variance; CODIACS, Comparison of Depression Interventions after Acute Coronary Syndrome; COPES, Coronary Psychosocial Evaluation Studies.

Figure 3

Forest plot showing depressive symptoms in collaborative care studies versus usual care or waiting list control (short term). IV, inverse variance; SD; CODIACS, Comparison of Depression Interventions after Acute Coronary Syndrome; COPES, Coronary Psychosocial Evaluation Studies; SUCCEED, Screening Utilization and CC for More Effective and Efficient Treatment of Depression, MOSAIC, Management of Sadness and Anxiety in Cardiology.

Figure 4

Forest plot showing depression remission in collaborative care studies versus usual care or waiting list control (short and medium terms). IV, inverse variance; CODIACS, Comparison of Depression Interventions after Acute Coronary Syndrome; COPES, Coronary Psychosocial Evaluation Studies; SUCCEED, Screening Utilization and CC for More Effective and Efficient Treatment of Depression, MOSAIC, Management of Sadness and Anxiety in Cardiology.