The effect of enhanced depression care on adherence to risk-reducing behaviors after acute coronary syndromes: findings from the COPES trial.
BACKGROUND
The presence of depression after an acute coronary syndrome (ACS) is associated with worse prognosis and lower adherence to risk-reducing behaviors. We reported earlier that an enhanced depression care intervention reduces depression symptoms and major adverse cardiac events. This study evaluates the impact of the depression intervention on health behavior and blood pressure control.


METHODS
Between 2005 and 2008, 157 patients who remained persistently depressed 3 months after ACS were randomized to a 6-month depression intervention (initial patient preference for problem-solving therapy and/or pharmacotherapy, followed by stepped care; 80 patients) or to usual care (77 patients). At randomization, and then 2, 4, and 6 months later, patients were asked if they (1) missed taking their aspirin; (2) followed a heart healthy diet; (3) exercised regularly; and (4) used tobacco products. Blood pressure was measured before randomization and 6 months later.


RESULTS
At the end of the intervention, there was no significant improvement in the percentage of intervention compared to control group patients who adhered to aspirin (+3% versus -1%, P = .23), followed a healthy diet (+10% versus +8%, P = .39), exercised regularly (+5% versus +4%, P = .65), abstained from tobacco (-3% versus -1%, P = .77), or had controlled blood pressure (+6% versus +16%, P = .26).


CONCLUSIONS
Despite improving depression, enhanced depression care after an ACS did not improve health behavior or blood pressure control compared to usual care. Research is needed to test whether adding an adherence intervention to enhanced depression care can improve adherence and cardiovascular prognosis in depressed patients post-ACS.
Center for Behavioral Cardiovascular Health, Columbia University Medical Center, PH9-311, 622W168th Street, New York, NY 10032, USA. ik2293@columbia.edu
Ian M
IM
Kronish
Nina
N
Rieckmann
Matthew M
MM
Burg
Donald
D
Edmondson
Joseph E
JE
Schwartz
Karina W
KW
Davidson
D054058:Acute Coronary Syndrome / Q000517:prevention & control / Q000523:psychology*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D003863:Depression / Q000209:etiology / Q000628:therapy*; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D006973:Hypertension / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D011340:Problem Solving; D011613:Psychotherapy / Q000379:methods; D040242:Risk Reduction Behavior; D000074606:Smoking Prevention
D000928:Antidepressive Agents; D001241:Aspirin