Telephone-Delivered Collaborative Care for Treating Post-CABG Depression - Bypassing the Blues
The goal of this trial was to compare a strategy of telephone-delivered collaborative care versus usual physician care among patients with depression after coronary artery bypass grafting (CABG).
Telephone-delivered collaborative care after CABG would be effective.
Patients Screened: 2,485
Patients Enrolled: 302
Mean Follow Up: 8 months
Mean Patient Age: 64 years
Mean Ejection Fraction: Mean 51%
- Patients with depression post-CABG
- Inability to provide consent
- Alcohol dependence or other substance abuse disorder
- Treatment with a mental health specialist
- Suicidal ideation
- History of psychotic illness
- Discharge to home or a short-term rehabilitation facility
- Non-English speaking
- No telephone access
- Mental HRQL measured by the SF-36 MCS at 8-month follow-up
- Mood symptoms (HRS-D)
- Physical HRQL (SF-36 PCS)
- Functional status (DASI)
- Hospital readmissions
Patients with depression after CABG were randomized to telephone-delivered collaborative care (n = 150) versus usual physician care (n = 152).
Intervention consisted of reviewing the patient's psychiatric history, providing basic education about depression, recommending pharmacotherapy treatment options (primary care physicians wrote prescriptions), and referring patients to a local mental health specialist.
Overall, 302 patients were randomized (56% of screened patients were positive for depression). In the treatment group, the mean age was 64 years, 19% were women, 60% had diabetes, mean ejection fraction was 51%, and 25% had been treated for depression in the last 2 years.
The change in Short Form-36 Mental Component Summary (SF-36 MCS) was 6.8 in the intervention group versus 3.6 in the usual care group (between group difference = 3.2; p = 0.02). The change in Hamilton Rating Scale for Depression (HRS-D) was 7.6 versus 4.5 (between group difference = 3.1; p = 0.001), change in SF-36 physical health-related quality of life (HRQL) (PCS) was 12.8 versus 11.1 (between group difference = 1.6; p = 0.14), and change in Duke Activity Status Index (DASI) was 18.1 versus 13.5 (between group difference = 4.6; p = 0.001), respectively. Men with depression were more likely to benefit from intervention (p = 0.01). Rehospitalization occurred in 33% versus 32% (p = NS), respectively.
Among depressed patients after CABG, use of telephone-delivered care resulted in improved HRQL, physical functioning, and mood symptoms at 8-month follow-up. Further research may be needed in women who demonstrated less improvement from this treatment strategy.
Rollman BL, Belnap BH, LeMenager MS, et al. Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial. JAMA 2009;302:2095-103.
Presented by Dr. Bruce Rollman at the American Heart Association Scientific Sessions, Orlando, FL, November 16, 2009.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention
Keywords: Depression, Depressive Disorder, Quality of Life, Physicians, Primary Care, Telephone, Coronary Disease, Coronary Artery Bypass, Mental Health, Diabetes Mellitus
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