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

• Authors: Karina W. Davidson, Columbia University; J. Thomas Bigger, Columbia University; Matthew M. Burg, Columbia University; Robert M. Carney, Washington University; William F. Chaplin, St John's University; Susan Czajkowski, National Heart, Lung, and Blood Institute; Ellen Dornelas, Yale University; Joan Duer-Hefele, Columbia University; Nancy Frasure-Smith, McGill University; Kenneth Freedland, Washington University; Donald C. Haas, Penn Cardiac Care Mercer Bucks; Allan S. Jaffe, Mayo Clinic; Joseph A. Ladapo, New York University; Francois Lesperance, University of Montreal; Vivian Medina, Columbia University; Jonathan D. Newman, Columbia University; Gabrielle A. Osorio, Columbia University; Faith Parsons, Columbia University; Joseph E. Schwartz, Columbia University; Jonathan A. Shaffer, Columbia University; Viola Vaccarino, Emory University
• Journal Title: JAMA Internal Medicine
• Volume: Volume 173, Number 11
• Publisher: American Medical Association (AMA) | 2013-06-10, Pages 997-1004
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1001/jamainternmed.2013.915
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; General & Internal Medicine; CARDIOVASCULAR-DISEASE PREVENTION; AMERICAN-HEART-ASSOCIATION; LONGER-TERM OUTCOMES; MYOCARDIAL-INFARCTION; COLLABORATIVE CARE; MAJOR DEPRESSION; PSYCHOSOCIAL-EVALUATION; COST-EFFECTIVENESS; RISK-FACTORS; HEALTH

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 prob-lem- 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.