TY - JOUR
T1 - Centralized, stepped, patient preference-based treatment for patients with post-acute coronary syndrome depression
T2 - CODIACS vanguard randomized controlled trial
AU - Davidson, Karina W.
AU - Bigger, J. Thomas
AU - Burg, Matthew M.
AU - Carney, Robert M.
AU - Chaplin, William F.
AU - Czajkowski, Susan
AU - Dornelas, Ellen
AU - Duer-Hefele, Joan
AU - Frasure-Smith, Nancy
AU - Freedland, Kenneth E.
AU - Haas, Donald C.
AU - Jaffe, Allan S.
AU - Ladapo, Joseph A.
AU - Lespérance, Francois
AU - Medina, Vivian
AU - Newman, Jonathan D.
AU - Osorio, Gabrielle A.
AU - Parsons, Faith
AU - Schwartz, Joseph E.
AU - Shaffer, Jonathan A.
AU - Shapiro, Peter A.
AU - Sheps, David S.
AU - Vaccarino, Viola
AU - Whang, William
AU - Ye, Siqin
PY - 2013/6/10
Y1 - 2013/6/10
N2 - 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. Trial Registration: clinicaltrials.gov Identifier: NCT01032018
AB - 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. Trial Registration: clinicaltrials.gov Identifier: NCT01032018
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U2 - 10.1001/jamainternmed.2013.915
DO - 10.1001/jamainternmed.2013.915
M3 - Article
C2 - 23471421
AN - SCOPUS:84876838419
SN - 2168-6106
VL - 173
SP - 997
EP - 1004
JO - JAMA internal medicine
JF - JAMA internal medicine
IS - 11
ER -