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Cited by 162Cardiac Health and Mental HealthMental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Centralized, Stepped, Patient Preference–Based Treatment for Patients With Post–Acute Coronary Syndrome Depression: CODIACS Vanguard Randomized Controlled Trial

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Davidson, Karina W., Bigger, J. Thomas, Burg, Matthew M., Carney, Robert M., Chaplin, William F., Czajkowski, Susan, Dornelas, Ellen, Duer-Hefele, Joan +17 more·2013·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2013.915PMC PMC3681929
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Abstract

IMPORTANCE: Controversy remains about whether depression can be successfully managed after acute coronary syndrome (ACS) and the costs and benefits of doing so. OBJECTIVE: To determine the effects of providing post-ACS depression care on depressive symptoms and health care costs. DESIGN: Multicenter randomized controlled trial. SETTING: Patients were recruited from 2 private and 5 academic ambulatory centers across the United States. PARTICIPANTS: A total of 150 patients with elevated depressive symptoms (Beck Depression Inventory [BDI] score ≥10) 2 to 6 months after an ACS, recruited between March 18, 2010, and January 9, 2012. INTERVENTIONS: Patients were randomized to 6 months of centralized depression care (patient preference for problem-solving treatment given via telephone or the Internet, pharmacotherapy, both, or neither), stepped every 6 to 8 weeks (active treatment group; n = 73), or to locally determined depression care after physician notification about the patient's depressive symptoms (usual care group; n = 77). MAIN OUTCOME MEASURES: Change in depressive symptoms during 6 months and total health care costs. RESULTS: Depressive symptoms decreased significantly more in the active treatment group than in the usual care group (differential change between groups, -3.5 BDI points; 95% CI, -6.1 to -0.7; P = .01). Although mental health care estimated costs were higher for active treatment than for usual care, overall health care estimated costs were not significantly different (difference adjusting for confounding, -$325; 95% CI, -$2639 to $1989; P = .78). CONCLUSIONS: For patients with post-ACS depression, active treatment had a substantial beneficial effect on depressive symptoms. This kind of depression care is feasible, effective, and may be cost-neutral within 6 months; therefore, it should be tested in a large phase 3 pragmatic trial. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01032018.

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  • Two follow-up randomized studies of related interventions for depression after acute coronary syndrome did not appear to find similar benefits on cardiac outcomes, although both examined small numbers of depressed patients (N=150 and 71) and were underpowered to detect effects on cardiac events.

    “However, 2 follow-up randomized studies of related interventions for depression after ACS did not appear to find similar benefits on cardiac outcomes, 191,192 although both of these studies examined small numbers of depressed patients (N=150 and 71) and were underpowered to detect effects on cardiac events.”

    From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [191]

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Authors
Davidson, K. W., Bigger, J. T., Burg, M. M., Carney, R. M., Chaplin, W. F., Czajkowski, S., Dornelas, E., Duer-Hefele, J., Frasure-Smith, N., Freedland, K. E., Haas, D. C., Jaffe, A. S., Ladapo, J. A., Lespérance, F., Medina, V., Newman, J. D., Osorio, G. A., Parsons, F., Schwartz, J. E., Shaffer, J. A., Shapiro, P. A., Sheps, D. S., Vaccarino, V., Whang, W., & Ye, S.
Affiliations
  • Columbia University Irving Medical Center (US)
  • University of Florida (US)
  • Washington University in St. Louis (US)
  • St. John's University (US)
  • National Institutes of Health (US)
  • Yale University (US)
  • Abington Memorial Hospital (US)
  • Mayo Clinic (US)
  • New York University (US)
  • Emory University (US)
Corresponding author
Davidson, Karina W.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2013-06-10
Volume
173
Issue
11
Pages
997
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2013.915
PMC
PMC3681929
OpenAlex
W2059675642
Cited by
162
References
57
Citations by year
2026: 5 · 2025: 9 · 2024: 13 · 2023: 14 · 2022: 14 · 2021: 13 · 2020: 3 · 2019: 10 · 2018: 10 · 2017: 14 · 2016: 17 · 2015: 16 · 2014: 15 · 2013: 9
FWCI
12.93
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Columbia Academic Commons (Columbia University)
Funders
  • Georgia Clinical and Translational Science Alliance
  • National Institutes of Health (UL1TR000040)
  • National Heart, Lung, and Blood Institute (HL 84034, K24HL084034, RC2HL101663, HL088117, R01HL114924, P01HL088117)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
depression care, stepped care, problem-solving therapy, internet-delivered treatment, antidepressant treatment, depressive symptoms, health care costs, cost neutrality, usual care
MeSH terms
Depression, Feasibility Studies, Female, Humans, Male, Middle Aged, Acute Coronary Syndrome, Patient Preference

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