Centralized, Stepped, Patient Preference–Based Treatment for Patients With Post–Acute Coronary Syndrome Depression

Davidson, Karina W.; Bigger, J. Thomas; Burg, Matthew M.; Carney, Robert M.; Chaplin, William F.; Czajkowski, Susan; Dornelas, Ellen; Duer-Hefele, Joan; Frasure-Smith, Nancy; Freedland, Kenneth E.; Haas, Donald C.; Jaffe, Allan S.; Ladapo, Joseph A.; Lespérance, Francois; Medina, Vivian M.; Newman, Jonathan D.; Osorio, Gabrielle A.; Parsons, Faith E.; Schwartz, Joseph E.; Shaffer, Jonathan A.; Shapiro, Peter A.; Sheps, David S.; Vaccarino, Viola; Whang, William; Ye, Siqin

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: Identifier: NCT01032018.


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JAMA Internal Medicine

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Academic Units
Center for Behavioral Cardiovascular Health
Published Here
April 1, 2016