(Ivanhoe Newswire) – 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.
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-hospitalization and death.
The "Bypassing the Blues" trial examined 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, a psychologist and an
internist.
"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," Bruce Rollman, M.D., M.P.H., principal investigator and
associate professor of medicine and psychiatry, University of Pittsburgh
School of Medicine, was quoted as saying. "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-hospitalizations 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 either to 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.
The researchers found that patients who received intervention reported
greater improvement in mental health-related quality of life, physical
functioning and mood symptoms. Half of the 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.
However, the mean health-related quality of life and physical functioning of
intervention patients did not reach that of the non-depressed comparison
group. Dr. Rollman noted, "Men with depression were particularly likely to
benefit from the intervention."
SOURCE: Journal of the American Medical Association (JAMA), November 18,
2009
