Telephone-Delivered Collaborative Care for Treating Post-CABG Depression - Bypassing the Blues

Nov 16, 2009
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
National Institutes of Health grants
Date Presented:
01/01/2009
Date Published:
01/01/2009
Date Updated:
11/16/2009
Original Posted Date:
11/16/2009
References

Description:

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).

Hypothesis:

Telephone-delivered collaborative care after CABG would be effective.

Study Design

  • Randomized
  • Blinded
  • Stratified

Patients Screened: 2,485
Patients Enrolled: 302
Mean Follow Up: 8 months
Mean Patient Age: 64 years
Female: 19%
Mean Ejection Fraction: Mean 51%

Patient Populations:

  • Patients with depression post-CABG

Exclusions:

  • 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

Primary Endpoints:

  • Mental HRQL measured by the SF-36 MCS at 8-month follow-up

Secondary Endpoints:

  • Mood symptoms (HRS-D)
  • Physical HRQL (SF-36 PCS)
  • Functional status (DASI)
  • Hospital readmissions

Drug/Procedures Used:

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.

Principal Findings:

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.

Interpretation:

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.

References:

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.

Keywords: Depression, Depressive Disorder, Quality of Life, Physicians, Primary Care, Telephone, Coronary Disease, Coronary Artery Bypass, Mental Health, Diabetes Mellitus


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