Collaborative Care Effective For Treating Depression and Anxiety in Recent Cardiac Patients

Depression and anxiety have been long associated with adverse cardiac events, with one often leading to an increased risk of the other.

A study published April 14 in JAMA Internal Medicine, found 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."

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The study was a single-blind, randomized clinical trial of 183 patients hospitalized for acute coronary syndrome, heart failure, or arrhythmia with symptoms of depression, generalized anxiety, or panic disorder, who were tested on whether the telephone-based collaborative mental health care treatment, delivered by a social worker and a team of psychiatrists, could improve mental and physical health across six months of treatment compared with usual care.

Overseen by Jeff Huffman, MD, Harvard Medical School, and his colleagues, the study found statistically and clinically significant improvements in mental health-related quality of life, the trial's primary outcome. Patients who received the treatment also experienced notable improvements in depressive symptoms, physical health-related quality of life, self-reported medication adherence, and functional capacity. Given the low-cost and low-intensity nature of the test's intervention and the large effect size and improvements observed, the Huffman et al. argued that such a program may be easily implemented and useful in a real-world setting.

In a related editorial comment, Katrina Davidson, PhD, Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University, and her co-authors wrote, "For decades, our health care system has reinforced separate systems for rewarding the care of patients, for example, by providing higher reimbursements for time spent performing procedures as compared with counseling patients with complex medical conditions. This approach has contributed to splintered and uncoordinated care. Arguably, this predilection for splitting has been most apparent in the way that physical and mental health care services are reimbursed. As a result of the changes in financing health care in the Affordable Care Act, we may be witnessing a paradigm shift that ripples through not only our health care delivery systems but also our science. Lumping together co-occurring risk factors, conditions, patient groups, and management strategies, particularly when one treatment may be an appropriate solution for many problems, may mark a new wave of science that emerges from our changing medical care reimbursement landscape."

Keywords: Depressive Disorder, Acute Coronary Syndrome, Panic Disorder, Counseling, Risk Factors, Single-Blind Method, Patient Protection and Affordable Care Act, Medication Adherence, Social Work, Quality of Life, Heart Failure, Mental Health Services

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