American
Heart Association Scientific Sessions 2009
A telephone-based collaborative care model increased
recovery time in patients who underwent CABG and improved mental and physical
health outcomes, according to data from the Bypassing the Blues trial.
“This is the first study to utilize a collaborative
care model to treat depression following an acute cardiac event,”Bruce
Rollman, MD, MPH, of the University of Pittsburgh, said during a press
conference.
A team of nurses utilized the Patient Health
Questionnaire to screen 2,485 patients for depression who underwent CABG at one
of seven Pittsburgh-area hospitals.
Researchers then randomly assigned 302 depressed
patients to either a “usual care” group or a collaborative care group
for eight months in comparison with a subset of 151 non-depressed patients who
underwent CABG.
Treatment options for the collaborative care model
included a self-help workbook, antidepressant pharmacotherapy and/or referral
to a community mental health specialist. Patients who chose to see a specialist
or pursue medication paid for it out-of-pocket.
The researchers used the Duke Activity Status Index to
assess physical functioning, SF-36 questionnaire to assess mental and physical
health and the Hamilton Rating Scale to assess mood symptoms.
At baseline, patients who were depressed had
significantly worse scores for all areas when compared with non-depressed
patients. At eight months follow-up, patients who received collaborative care
had significant improvements in all scores when compared with patients who
received usual care.
Depressed patients were more likely to report 50% or
more decline in adverse mood symptoms (50% vs. 29.6%; %; P<.001)
— this was particularly true for men (60.5% vs. 33.3%;
P<.001).
Further, men had a lower likelihood for
re-hospitalization from CVD causes at eight months when compared with men who
were depressed assigned to usual care (13% vs. 23%; P=.07).
“We were able to demonstrate that our intervention
significantly improved quality of life and reduced adverse symptoms as early as
two months following surgery as well as reduced re-hospitalization in depressed
men at eight months,” Rollman said. – by Jennifer Southall
Rollman B. LBCT.03. Presented at: the American Heart Association 2009
Scientific Session; Nov. 14-18, 2009; Orlando, Fla.
Depression following a major cardiac surgery is a common problem. This
study was well designed and demonstrated that relatively minor interventions
can add a significant nature to quality of life and mood changes to patients
who undergo CABG as well as reduced re-hospitalizations in the male population.
However, this is not the final answer as it did not address all issues. But it
does add a lot to our knowledge of the care for patients following bypass
surgery.
– Frank W. Sellke, MD
Chief, division of cardiothoracic surgery
Alpert Medical School of Brown University
