Collaborative Care for Depression and Anxiety Disorders in Patients With Recent Cardiac Events: The Management of Sadness and Anxiety in Cardiology (MOSAIC) Randomized Clinical Trial

Study Questions:

Does a low-intensity intervention involving collaborative care improve depression, generalized anxiety disorder, and/or panic disorder among patients hospitalized for an acute cardiac condition?

Methods:

This was a single-blind randomized clinical trial, conducted from September 2010 through July 2018. Patients admitted to the in-patient cardiac units in an urban academic general hospital for acute coronary syndrome, arrhythmia, or heart failure and found to have clinical depression, generalized anxiety disorder, or panic disorders were eligible for the study. Participants were randomized to 24 weeks of a low-intensity telephone-based multicomponent collaborative care intervention targeting depression and anxiety disorders (n = 92), or to enhanced usual care (serial notification of primary medical providers; n = 91). The collaborative care intervention used a social work care manager to coordinate assessment and stepped care of psychiatric conditions, and to provide support and therapeutic interventions as appropriate. The primary outcomes of interest were improvement in mental health–related quality of life (Short Form-12 Mental Component Score [SF-12MCS]) at 24 weeks, compared between groups using a random-effects model in an intent-to-treat analysis.

Results:

Of the 223 patients who met all eligibility criteria, 183 (82%) were enrolled. Overall, 133 patients met criteria for depression, 118 for generalized anxiety disorder, and 19 for panic disorder. Ninety-two participants were randomized to collaborative care and 91 to usual care. Participants’ mean (standard deviation) age was 60.5 (12.7) years, 53% were women, 90% were white, and admission diagnosis was evenly distributed across the four possible cardiac diagnoses. Follow-up data at one or more time points were available for 172 patients (94%). Patients randomized to collaborative care had significantly greater estimated mean improvements in mental health–related quality of life at 24 weeks (11.21 points [from 34.21 to 45.42] in the collaborative care group vs. 5.53 points [from 36.30 to 41.83] in the control group; estimated mean difference, 5.68 points [95% confidence interval, 2.14-9.22]; p = 0.002; effect size, 0.61). Patients receiving collaborative care also had significant improvements in depressive symptoms and general functioning, and higher rates of treatment of a mental health disorder; anxiety scores, rates of disorder response, and adherence did not differ between groups.

Conclusions:

The investigators concluded that a novel telephone-based, low-intensity model to concurrently manage cardiac patients with depression and/or anxiety disorders was effective for improving mental health–related quality of life in a 24-week trial.

Perspective:

Rates of depression, anxiety, and panic disorders are high among cardiac patients. Interventions that are cost-effective and acceptable to patients are clinically important. Treatments of these disorders may translate into improvements in lifestyle, quality of life, and adherence to cardiovascular treatments. Longer-term studies using low-intensity collaborative care intervention in larger cohorts is warranted.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Depression, Life Style, Acute Coronary Syndrome, Follow-Up Studies, Panic Disorder, Single-Blind Method, Social Work, Quality of Life, Research Personnel, Heart Failure, Confidence Intervals, Mental Health, Primary Health Care, Hospitals, General


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