Bypassing the blues

Coronary artery bypass graft (CABG) patients who were screened for depression after surgery and then cared for by a nurse-led team of health care specialists via telephone reported improved quality of life and physical function compared to those who received their doctors’ usual care, according to a study from the University of Pittsburgh School of Medicine. Study findings, published in the 18 November edition of the Journal of the American Medical Association (JAMA), also presented in a late-breaking clinical trials plenary session at the American Heart Association (AHA) Annual Meeting, 16 November in Orlando, Fla.

With more than 450,000 procedures performed annually, CABG surgery is one of the most frequently performed and costly medical procedures in the United States. Although the procedure clearly benefits many individuals, 20 to 25 percent experience depressive symptoms following CABG surgery. Those with depressive symptoms have worse clinical outcomes, including poorer quality of life, continued chest pains and a higher risk of re-hospitalisation and death.

"Bypassing the Blues" is the first trial to examine the impact of a collaborative care strategy for treating depression following an acute cardiac event. The intervention included weekly telephone follow-up by a nurse using an evidence-based treatment protocol for depression. The nurse collaborated with the patients’ primary care physicians and the study’s clinical management team, composed of a psychiatrist, psychologist and internist. This approach has proven effective for treating major depression in primary care settings but had never before been applied to a population with cardiac disease.

"Dozens of studies have described a link between depression and heart disease, and the most recent science advisory from the American Heart Association recommends screening patients with heart disease for depression," said Bruce Rollman, MD, MPH, associate professor of medicine and psychiatry, Center for Research on Health Care, University of Pittsburgh School of Medicine, and the study’s principal investigator. "However, few depression treatment trials have involved cardiac patients and none used the collaborative care model or examined the impact of treating post-CABG depression on quality of life, re-hospitalisations or health care costs, as we did."

Investigators recruited 453 post-CABG patients from seven Pittsburgh-area hospitals, from 2004 through 2007. They included 302 depressed patients who were randomly assigned to either an eight-month course of telephone-delivered collaborative care or to their doctors’ usual care for depression. Investigators also randomly sampled an additional 151 non-depressed, post-CABG patients to facilitate comparisons to depressed patients. They tracked these patients to monitor quality of life, physical functioning, mood symptoms, re-hospitalisations, health care costs and deaths.

The researchers found that intervention patients reported greater improvements in mental health-related quality of life, physical functioning and mood symptoms. Overall, 50 percent of intervention patients reported a 50 percent or greater reduction in mood symptoms from baseline to eight-month follow-up versus 29.6 percent of patients in usual care. "Men with depression were particularly likely to benefit from the intervention. However, the mean health-related quality of life and physical functioning of intervention patients did not reach that of the non-depressed comparison group," said Dr Rollman.

(Source: University of Pittsburgh: Journal of the American Medical Association: November 2009)