Centralized, stepped, patient preference-based treatment for patients with post-acute coronary syndrome depression: CODIACS vanguard randomized controlled trial

Karina W. Davidson, J. Thomas Bigger, Matthew M. Burg, Robert M. Carney, William F. Chaplin, Susan Czajkowski, Ellen Dornelas, Joan Duer-Hefele, Nancy Frasure-Smith, Kenneth E. Freedland, Donald C. Haas, Allan S. Jaffe, Joseph A. Ladapo, Francois Lespérance, Vivian Medina, Jonathan D. Newman, Gabrielle A. Osorio, Faith Parsons, Joseph E. Schwartz, Jonathan A. ShafferPeter A. Shapiro, David S. Sheps, Viola Vaccarino, William Whang, Siqin Ye

Research output: Contribution to journalArticlepeer-review

82 Scopus citations

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. Trial Registration: clinicaltrials.gov Identifier: NCT01032018

Original languageEnglish (US)
Pages (from-to)997-1004
Number of pages8
JournalJAMA internal medicine
Volume173
Issue number11
DOIs
StatePublished - Jun 10 2013

ASJC Scopus subject areas

  • Internal Medicine

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