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Randomized Controlled Trial
. 2025;94(5):324-342.
doi: 10.1159/000545865. Epub 2025 May 23.

Efficacy of Team-Based Collaborative Care for Distressed Patients in Secondary Prevention of Chronic Coronary Heart Disease: Results from the Multicenter, Randomized Controlled TEACH Trial

Monika Sadlonova  1   2   3   4   5 , Birgit Herbeck Belnap  1   6 , Ingrid Becker  7 , Kristina Bersch  8 , Franziska Geiser  9 , Viktoria Adenauer  10 , Martin Hellmich  7   11 , Ingrid Kindermann  12 , Angela Zimmer  12 , Matthias Michal  13 , Jasmin Ghaemi Kerahrodi  13 , Mariel Nöhre  14 , Martina de Zwaan  14 , Astrid Petersmann  15 , Irina Müller-Kozarez  16 , Maja Ehlers  17 , Rolf Wachter  5   16 , Christian Albus  17 , Christoph Herrmann-Lingen  1   5 ; TEACH investigators
Affiliations
Randomized Controlled Trial

Efficacy of Team-Based Collaborative Care for Distressed Patients in Secondary Prevention of Chronic Coronary Heart Disease: Results from the Multicenter, Randomized Controlled TEACH Trial

Monika Sadlonova et al. Psychother Psychosom. 2025.

Abstract

<p>Introduction: Coronary heart disease (CHD) has serious implications for patients' quality of life (QoL). Psychological distress affects 15-40% of patients with CHD and is robustly associated with poorer prognosis. Blended collaborative care (BCC), a telephone-delivered intervention involving non-physician care managers that addresses both psychological and medical factors, can be applied for secondary prevention of CHD.

Methods: We conducted the multicenter, randomized controlled TEACH trial that investigated the efficacy of a BCC intervention (TeamCare) in distressed CHD patients. The primary aim was to examine the treatment response rate of TeamCare, defined as ≥50% improvements in health-related QoL (HRQoL, assessed by HeartQoL) after 12 months compared to usual care (UC). Secondary endpoints were changes in HRQoL, psychological and medical factors, and satisfaction with care.

Results: In total, 457 patients (mean age 62.9 ± 9.5 years, 23% females) were randomized to TeamCare (n = 230) or UC (n = 227). At 12 months, TeamCare patients showed a significantly higher proportion of treatment response to HeartQoL compared to UC (19% vs. 10%, respectively). TeamCare yielded significantly greater improvements in HeartQoL scores: global (d = 0.338), physical (d = 0.270), and emotional (d = 0.382). Further, TeamCare led to a significantly greater decrease in depression (d = -0.329), anxiety (d = -0.300), perceived stress (d = -0.233), and medical risk score (d = -0.235). Finally, BCC patients showed a higher satisfaction with overall treatment and psychosocial care.

Conclusion: The TEACH study is the first ever performed BCC trial in distressed CHD patients in Europe. The BCC intervention has the potential to significantly improve secondary prevention in distressed CHD patients. </p>.

Keywords: Blended collaborative care; Cardiovascular risk factors; Coronary heart disease; Psychological distress; Randomized controlled trial; Secondary prevention.

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Conflict of interest statement

R.W. reports receiving personal fees from AstraZeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, CVRx, Daiichi Sankyo, Medtronic, Novartis, Pfizer, Pharmacosmos, and Servier and research support from Boehringer Ingelheim, German Ministry of Education and Research, the German Research Foundation, the European Union and Medtronic, outside the submitted work. C.A. received lecture honoraria from Bayer Vital and research funding from the German Ministry of Education and Research and the Commission of the European Union. C.H.-L. reports that he is receiving royalties from Hogrefe Huber Publishers for the German version of the HADS. During the last 3 years, he has received a lecture honorarium from Pfizer and research support from the German Ministry of Education and Research, the German Research Foundation and the European Commission, all unrelated to this research. Others declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Fig. 1.
Fig. 1.
CONSORT flow diagram of the TEACH trial. CHD, coronary heart disease; HADS, Hospital Anxiety and Depression Scale; PSS-4, 4-item Perceived Stress Scale; RF, risk factor; ACS, acute coronary syndrome; CABG, coronary artery bypass graft surgery. *1 patient with negative initial distress screening; **6 patients with no documentation of an uncontrolled medical risk factor.
Fig. 2.
Fig. 2.
Forest plot of effect size (Cohen’s d) for change of secondary outcomes as group comparisons between TeamCare and UC from baseline to 12-month follow-up. All outcomes are coded such that a positive effect size favors the TeamCare group. CI, confidence interval; HADS, Hospital Anxiety and Depression Scale; PSS-4, 4-item Perceived Stress Scale; TC, TeamCare; UC, usual care.
Fig. 3.
Fig. 3.
a–c Changes in HeartQoL scores as group comparisons between TeamCare and UC from baseline to 12-month follow-up. a HeartQoL global score. b HeartQoL emotional score. c HeartQoL physical score. The figures show mean profiles with 95% CIs.
Fig. 4.
Fig. 4.
a–d Changes in depression, anxiety, distress and number of medical risk factors as group comparisons between TeamCare and UC from baseline to 12-month follow-up. a HADS depression score. b HADS anxiety score. c PSS-4 distress score. d Number of medical risk factors. HADS, Hospital Anxiety and Depression Scale; PSS-4, 4-item Perceived Stress Scale. The figures show mean profiles with 95% CIs.
See this image and copyright information in PMC

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