Long-term outcomes of enhanced depression treatment in patients with acute coronary syndromes.
BACKGROUND
The Coronary Psychosocial Evaluation Studies trial demonstrated promising results for enhanced depression treatment to reduce cardiovascular risk of patients with acute coronary syndrome and comorbid depression, but the long-term effectiveness of this intervention is unclear.


METHODS
A total of 157 participants with persistent depression after hospitalization for acute coronary syndromes were enrolled in the Coronary Psychosocial Evaluation Studies trial. A total of 80 participants were allocated to 6 months of enhanced depression treatment, and 77 participants were allocated to usual care. We report on an additional 12 months of observational follow-up for the composite outcome of death or first hospitalization for myocardial infarction or unstable angina.


RESULTS
Although the intervention was previously shown to have favorable cardiovascular effects during the treatment period, we observed a significant time-by-treatment group interaction during extended follow-up (P = .008). Specifically, during the 6-month treatment period, death or hospitalization for myocardial infarction/unstable angina occurred in 3 participants (4%) in the treatment group compared with 11 participants (14%) in the usual care group (hazard ratio, 0.25; 95% confidence interval, 0.07-0.90; P = .03). In contrast, during 12 months of additional observational follow-up, 11 participants (14%) in the treatment group experienced the composite outcome of death or hospitalization for myocardial infarction/unstable angina compared with 3 participants (4%) in the usual care group (hazard ratio, 2.91; 95% confidence interval, 0.80-10.56; P = .10).


CONCLUSIONS
Enhanced depression treatment was associated with a reduced risk of death or hospitalization for myocardial infarction/unstable angina during active treatment, but this effect did not persist after treatment ceased. Future research is needed to confirm our findings and to determine the optimal duration of depression treatment in patients with depression after acute coronary syndromes.
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University College of Physician & Surgeons, New York, NY. Electronic address: sy2357@columbia.edu.
Siqin
S
Ye
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University College of Physician & Surgeons, New York, NY.
Jonathan A
JA
Shaffer
Berlin School of Public Health, Charité Universitätsmedizin, Berlin, Germany.
Nina
N
Rieckmann
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University College of Physician & Surgeons, New York, NY; Department of Psychiatry and Behavioral Sciences, SUNY-Stony Brook University, Stony Brook, NY.
Joseph E
JE
Schwartz
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University College of Physician & Surgeons, New York, NY.
Ian M
IM
Kronish
Department of Population Health, New York University School of Medicine, New York.
Joseph A
JA
Ladapo
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University College of Physician & Surgeons, New York, NY.
William
W
Whang
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University College of Physician & Surgeons, New York, NY; Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn.
Matthew M
MM
Burg
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University College of Physician & Surgeons, New York, NY.
Karina W
KW
Davidson
D054058:Acute Coronary Syndrome / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D000789:Angina, Unstable / Q000453:epidemiology* / Q000517:prevention & control; D002423:Cause of Death; D015897:Comorbidity; D065187:Controlled Before-After Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000517:prevention & control; D010043:Outcome and Process Assessment, Health Care; D016016:Proportional Hazards Models; D013997:Time Factors
Acute coronary syndrome; Depression