title: Centralized, stepped, patient preference-based treatment for patients with post-acute coronary syndrome depression: CODIACS vanguard randomized controlled trial.
abstract: OBJECTIVE
  Controversy remains about whether depression can be successfully managed after acute coronary syndrome (ACS) and the costs and benefits of doing so.
  
  
  OBJECTIVE
  To determine the effects of providing post-ACS depression care on depressive symptoms and health care costs.
  
  
  METHODS
  Multicenter randomized controlled trial.
  
  
  METHODS
  Patients were recruited from 2 private and 5 academic ambulatory centers across the United States.
  
  
  METHODS
  A total of 150 patients with elevated depressive symptoms (Beck Depression Inventory [BDI] score ≥10) 2 to 6 months after an ACS, recruited between March 18, 2010, and January 9, 2012.
  
  
  METHODS
  Patients were randomized to 6 months of centralized depression care (patient preference for problem-solving treatment given via telephone or the Internet, pharmacotherapy, both, or neither), stepped every 6 to 8 weeks (active treatment group; n = 73), or to locally determined depression care after physician notification about the patient's depressive symptoms (usual care group; n = 77).
  
  
  METHODS
  Change in depressive symptoms during 6 months and total health care costs.
  
  
  RESULTS
  Depressive symptoms decreased significantly more in the active treatment group than in the usual care group (differential change between groups, -3.5 BDI points; 95% CI, -6.1 to -0.7; P = .01). Although mental health care estimated costs were higher for active treatment than for usual care, overall health care estimated costs were not significantly different (difference adjusting for confounding, -$325; 95% CI, -$2639 to $1989; P = .78).
  
  
  CONCLUSIONS
  For patients with post-ACS depression, active treatment had a substantial beneficial effect on depressive symptoms. This kind of depression care is feasible, effective, and may be cost-neutral within 6 months; therefore, it should be tested in a large phase 3 pragmatic trial.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01032018.
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Bigger
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Burg
authors.forename: Robert M
authors.initials: RM
authors.lastname: Carney
authors.forename: William F
authors.initials: WF
authors.lastname: Chaplin
authors.forename: Susan
authors.initials: S
authors.lastname: Czajkowski
authors.forename: Ellen
authors.initials: E
authors.lastname: Dornelas
authors.forename: Joan
authors.initials: J
authors.lastname: Duer-Hefele
authors.forename: Nancy
authors.initials: N
authors.lastname: Frasure-Smith
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Freedland
authors.forename: Donald C
authors.initials: DC
authors.lastname: Haas
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Ladapo
authors.forename: Francois
authors.initials: F
authors.lastname: Lespérance
authors.forename: Vivian
authors.initials: V
authors.lastname: Medina
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Newman
authors.forename: Gabrielle A
authors.initials: GA
authors.lastname: Osorio
authors.forename: Faith
authors.initials: F
authors.lastname: Parsons
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Shaffer
authors.forename: Peter A
authors.initials: PA
authors.lastname: Shapiro
authors.forename: David S
authors.initials: DS
authors.lastname: Sheps
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: William
authors.initials: W
authors.lastname: Whang
authors.forename: Siqin
authors.initials: S
authors.lastname: Ye
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications; D003863:Depression / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference