Telephone-Delivered Collaborative Care for Treating Post-CABG Depression: A Randomized Controlled Trial
Open accessAbstract
CONTEXT: Depressive symptoms commonly follow coronary artery bypass graft (CABG) surgery and are associated with less positive clinical outcomes. OBJECTIVE: To test the effectiveness of telephone-delivered collaborative care for post-CABG depression vs usual physician care. DESIGN, SETTING, AND PARTICIPANTS: Single-blind effectiveness trial at 7 university-based and community hospitals in or near Pittsburgh, Pennsylvania. Participants were 302 post-CABG patients with depression (150, intervention; 152, usual care) and a comparison group of 151 randomly sampled post-CABG patients without depression recruited between March 2004 and September 2007 and observed as outpatients until June 2008. INTERVENTION: Eight months of telephone-delivered collaborative care provided by nurses working with patients' primary care physicians and supervised by a psychiatrist and primary care physician from this study. MAIN OUTCOME MEASURES: Mental health-related quality of life (HRQL) measured by the Short Form-36 Mental Component Summary (SF-36 MCS) at 8-month follow-up; secondary outcome measures included assessment of mood symptoms (Hamilton Rating Scale for Depression [HRS-D]), physical HRQL (SF-36 PCS), and functional status (Duke Activity Status Index [DASI]); and hospital readmissions. RESULTS: The intervention patients reported greater improvements in mental HRQL (all P < or = .02) (SF-36 MCS: Delta, 3.2 points; 95% confidence interval [CI], 0.5-6.0), physical functioning (DASI: Delta, 4.6 points; 95% CI, 1.9-7.3), and mood symptoms (HRS-D: Delta, 3.1 points; 95% CI, 1.3-4.9); and were more likely to report a 50% or greater decline in HRS-D score from baseline (50.0% vs 29.6%; number needed to treat, 4.9 [95% CI, 3.2-10.4]) than usual care patients (P < .001). Men with depression were particularly likely to benefit from the intervention (SF-36 MCS: Delta, 5.7 points; 95% CI, 2.2-9.2; P = .001). However, the mean HRQL and physical functioning of intervention patients did not reach that of the nondepressed comparison group. CONCLUSION: Compared with usual care, telephone-delivered collaborative care for treatment of post-CABG depression resulted in improved HRQL, physical functioning, and mood symptoms at 8-month follow-up. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00091962.
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The collaborative care trials were not fully powered for major cardiac outcomes, and absolute rates of cardiac events or mortality were highly similar in intervention and control conditions, suggesting that even substantially larger trials may have observed no effect.
“Although these trials were not fully powered for major cardiac outcomes, absolute rates of cardiac events or mortality were highly similar in intervention and control conditions in these studies, suggesting that even substantially larger trials may have observed no effect.”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [189]
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Experimental — accuracy not yet measuredCoronary 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 [84]
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 [84]
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Rollman, B. L., Herbeck Belnap, B., Mazumdar, S., Houck, P. R., He, F., Alvarez, R. J., Schulberg, H. C., Reynolds, C. F., & McNamara, D. M. (2012) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2011.11.002 · Cited by 56 · see citing works
Self-citation
- Authors
- Rollman, B. L., Belnap, B. H., LeMenager, M. S., Mazumdar, S., Houck, P. R., Counihan, P. J., Kapoor, W. N., Schulberg, H. C., & Reynolds, C. F.
- Affiliations
- University of Pittsburgh (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2009-11-18
- Volume
- 302
- Issue
- 19
- Pages
- 2095
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3010227
- OpenAlex
- W2018228451
- Cited by
- 343
- References
- 70
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 7 · 2023: 10 · 2022: 13 · 2021: 13 · 2020: 10 · 2019: 15 · 2018: 17 · 2017: 19 · 2016: 28 · 2015: 28 · 2014: 25 · 2013: 34 · 2012: 34
- FWCI
- 22.86
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R01HL070000, R01 HL70000)
- National Institute of Mental Health (P30-MH 71944, P30MH071944)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- depression treatment, mental health-related quality of life, physical function, mood symptoms, hospital readmission, cardiac surgery outcomes, nurse-led care, primary care
- MeSH terms
- Aged, Antidepressive Agents, Coronary Artery Bypass, Continuity of Patient Care, Depression, Depressive Disorder, Female, Health Status Indicators, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Patient Care Team, Patient Education as Topic, Telephone, Single-Blind Method, Telemedicine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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