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Enhanced Depression Care for Patients With Acute Coronary Syndrome and Persistent Depressive Symptoms: Coronary Psychosocial Evaluation Studies Randomized Controlled Trial

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Davidson, Karina W., Rieckmann, Nina, Clemow, Lynn, Schwartz, Joseph E., Shimbo, Daichi, Medina, Vivian, Albanese, Gabrielle, Kronish, Ian +2 more·2010·Archives of Internal Medicine
DOI 10.1001/archinternmed.2010.29PMC PMC2882253
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Abstract

BACKGROUND: Depressive symptoms are an established predictor of mortality and major adverse cardiac events (defined as nonfatal myocardial infarction or hospitalization for unstable angina or urgent/emergency revascularizations) in patients with acute coronary syndrome (ACS). This study was conducted to determine the acceptability and efficacy of enhanced depression treatment in patients with ACS. METHODS: A 3-month observation period to identify patients with ACS and persistent depressive symptoms was followed by a 6-month randomized controlled trial. From January 1, 2005, through February 29, 2008, 237 patients with ACS from 5 hospitals were enrolled, including 157 persistently depressed patients randomized to intervention (initial patient preference for problem-solving therapy and/or pharmacotherapy, then a stepped-care approach; 80 patients) or usual care (77 patients) and 80 nondepressed patients who underwent observational evaluation. The primary outcome was patient satisfaction with depression care. Secondary outcomes were depressive symptom changes (assessed with the Beck Depression Inventory), major adverse cardiac events, and death. RESULTS: At the end of the trial, the proportion of patients who were satisfied with their depression care was higher in the intervention group (54% of 80) than in the usual care group (19% of 77) (odds ratio, 5.4; 95% confidence interval [CI], 2.2-12.9 [P < .001]). The Beck Depression Inventory score decreased significantly more (t(155) = 2.85 [P = .005]) for intervention patients (change, -5.7; 95% CI, -7.6 to -3.8; df = 155) than for usual care patients (change, -1.9; 95% CI, -3.8 to -0.1; df = 155); the depression effect size was 0.59 of the standard deviation. At the end of the trial, 3 intervention patients and 10 usual care patients had experienced major adverse cardiac events (4% and 13%, respectively; log-rank test, chi(2)(1) = 3.93 [P = .047]), as well as 5 nondepressed patients (6%) (for the intervention vs nondepressed cohort, chi(2)(1) = 0.48 [P = .49]). CONCLUSION: Enhanced depression care for patients with ACS was associated with greater satisfaction, a greater reduction in depressive symptoms, and a promising improvement in prognosis. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00158054.

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  • COPES delivered 6 months of depression stepped care to 157 patients with acute coronary syndrome with persistent depressive symptoms; the intervention led to significant improvements in depression and to lower rates of major adverse cardiac events (4% versus 13%; P=0.047) compared with usual care.

    “COPES (Coronary Psychosocial Evaluation Study) delivered 6 months of depression stepped care to 157 patients with ACS with persistent depressive symptoms; the intervention led to significant improvements in depression and to lower rates of major adverse cardiac events (4% versus 13%; P =0.047; no RR or CI reported) compared with usual care. 190”

    From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [190]

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  • Coronary patients with clinically significant depression can be safely and effectively treated with psychotherapy or SSRIs, but evidence for a beneficial effect on cardiac endpoints is inconclusive.

    “Coronary patients with clinically significant depression can be safely and effectively treated with psychotherapy 84,85,351 -353 or selective serotonin re-uptake inhibitors, 354 -356 although evidence for a beneficial effect on cardiac endpoints is inconclusive.”

    From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [85]

  • Most studies showed no significant beneficial effect of treating depression on cardiac endpoints, but a recent RCT revealed fewer depressive symptoms and fewer major adverse cardiac events.

    “Whereas most studies could show no significant beneficial effect, 84,351 -356 a recent RCT revealed fewer depressive symptoms as well as fewer major adverse cardiac events.85”

    From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [85]

  • Multimodal behavioural interventions can reduce mood symptoms and enhance health-related quality of life, although evidence for a definite beneficial effect on cardiac endpoints is inconclusive.

    “This approach can reduce mood symptoms and enhance health-related quality of life, although evidence for a definite beneficial effect on cardiac endpoints is inconclusive.”

    From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [85]

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  1. [52]Frasure-Smith N Lespérance F Heterogeneity of patients with coronary artery disease and distress and the need to identify relevant subtypes [author reply] Arch Gen Psychiatry 2008 65 7 852 853 18606957

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Authors
Davidson, K. W., Rieckmann, N., Clemow, L., Schwartz, J. E., Shimbo, D., Medina, V., Albanese, G., Kronish, I., Hegel, M., & Burg, M. M.
Affiliations
  • Columbia University Irving Medical Center (US)
  • Mount Sinai Hospital (US)
ORCID
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
2010-04-12
Volume
170
Issue
7
Pages
600-8
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinternmed.2010.29
PMC
PMC2882253
OpenAlex
W2073419058
Cited by
350
References
67
Citations by year
2026: 5 · 2025: 9 · 2024: 16 · 2023: 15 · 2022: 12 · 2021: 9 · 2020: 52 · 2019: 11 · 2018: 17 · 2017: 22 · 2016: 14 · 2015: 25 · 2014: 23 · 2013: 39 · 2012: 34
FWCI
25.69
Type
journal article
Language
en
Open access
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Columbia Academic Commons (Columbia University)
Funders
  • National Institutes of Health (n01hc25197-0-0-0, RR024156, HL-76857)
  • National Heart, Lung, and Blood Institute (HL 84034, HC25197, R24HL076857, K24HL084034, HL76857, N01 HC025197, R01HL079235)
  • National Center for Research Resources (UL1RR024156)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
acute coronary syndrome, persistent depressive symptoms, depression treatment, problem-solving therapy, antidepressant treatment, patient satisfaction, major adverse cardiac events, mortality, depression and cardiovascular risk, Beck Depression Inventory, usual care comparison
MeSH terms
Adaptation, Psychological, Aged, Antidepressive Agents, Depression, Depressive Disorder, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Problem Solving, Surveys and Questionnaires, Regression Analysis, Severity of Illness Index, Sex Factors, Cognitive Behavioral Therapy, Chi-Square Distribution, Treatment Outcome, Patient Satisfaction, Patient Selection, Kaplan-Meier Estimate, Acute Coronary Syndrome

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