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


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


BACKGROUND
clinicaltrials.gov Identifier: NCT00158054.
Davidson
Karina W
KW
Department of Medicine, Columbia University College of Physicians and Surgeons, PH9 Center, 622 W 168th St, Room 948, New York, NY 10032, USA. kd2124@columbia.edu
Rieckmann
Nina
N
Clemow
Lynn
L
Schwartz
Joseph E
JE
Shimbo
Daichi
D
Medina
Vivian
V
Albanese
Gabrielle
G
Kronish
Ian
I
Hegel
Mark
M
Burg
Matthew M
MM
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000523:psychology; D000223:Adaptation, Psychological; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003866:Depressive Disorder / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D018579:Patient Selection; D011340:Problem Solving; D012044:Regression Analysis; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000928:Antidepressive Agents
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