Enhanced Depression Care for Patients With Acute Coronary Syndrome and Persistent Depressive Symptoms: Coronary Psychosocial Evaluation Studies Randomized Controlled Trial | Acute Coronary Syndromes | JAMA Internal Medicine | JAMA Network
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Original Investigation
April 12, 2010

Enhanced Depression Care for Patients With Acute Coronary Syndrome and Persistent Depressive Symptoms: Coronary Psychosocial Evaluation Studies Randomized Controlled Trial

Author Affiliations

Author Affiliations: Department of Medicine, Columbia University College of Physicians and Surgeons (Drs Davidson, Clemow, Schwartz, Shimbo, and Burg and Ms Albanese), Cardiovascular Institute (Dr Davidson and Ms Medina), and Departments of Psychiatry (Drs Davidson and Rieckmann) and General Internal Medicine (Dr Kronish), Mount Sinai School of Medicine, New York, New York; Berlin School of Public Health, Charité University Medical Center, Berlin, Germany (Dr Rieckmann); and Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire (Dr Hegel).

Arch Intern Med. 2010;170(7):600-608. doi:10.1001/archinternmed.2010.29
Abstract

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 (t155 = 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, χ21 = 3.93 [P = .047]), as well as 5 nondepressed patients (6%) (for the intervention vs nondepressed cohort, χ21 = 0.48 [P = .49]).

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

Trial Registration  clinicaltrials.gov Identifier: NCT00158054

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