Centralized, Stepped, Patient Preference–Based Treatment for Patients With Post–Acute Coronary Syndrome Depression: CODIACS Vanguard Randomized Controlled Trial | Acute Coronary Syndromes | JAMA Internal Medicine | JAMA Network
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Original Investigation
June 10, 2013

Centralized, Stepped, Patient Preference–Based Treatment for Patients With Post–Acute Coronary Syndrome Depression: CODIACS Vanguard Randomized Controlled Trial

Author Affiliations

Author Affiliations: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York (Drs Davidson, Bigger, Burg, Newman, Schwartz, Shaffer, Shapiro, Whang, and Ye and Mss Duer-Hefele, Medina, Osorio, and Parsons); Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri (Drs Carney and Freedland); Department of Psychology, St John's University, Jamaica, New York (Dr Chaplin); Behavioral Medicine Scientific Research Group, Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland (Dr Czajkowski); Department of Medicine, Hartford Hospital, Yale University, New Haven, Connecticut (Dr Dornelas); Department of Psychiatry, McGill University, Montreal, Quebec, Canada (Dr Frasure-Smith); Department of Psychiatry, University of Montreal, Montreal (Drs Frasure-Smith and Lespérance); Department of Medicine, Penn Cardiac Care at Mercer Bucks, Yardley, Pennsylvania (Dr Haas); Department of Medicine, Mayo Clinic, Rochester, Minnesota (Dr Jaffe); Department of Medicine, New York University, New York (Dr Ladapo); Department of Psychiatry and Behavioral Science, SUNY–Stony Brook University, Stony Brook, New York (Dr Schwartz); Department of Medicine, University of Florida, Gainesville (Dr Sheps); and Department of Epidemiology, Emory University School of Public Health and School of Medicine, Atlanta, Georgia (Dr Vaccarino). Dr Haas is now with the Department of Medicine, Abington Memorial Hospital, Abington, Pennsylvania.

JAMA Intern Med. 2013;173(11):997-1004. doi:10.1001/jamainternmed.2013.915

Importance 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.

Design Multicenter randomized controlled trial.

Setting Patients were recruited from 2 private and 5 academic ambulatory centers across the United States.

Participants 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.

Interventions 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).

Main Outcome Measures 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.

Trial Registration clinicaltrials.gov Identifier: NCT01032018