Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial

Abstract

Context: Depressive symptoms commonly follow coronary artery bypass graft (CABG) surgery and are associated with less positive clinical outcomes.

Objective: To test the effectiveness of telephone-delivered collaborative care for post-CABG depression vs usual physician care.

Design, setting, and participants: Single-blind effectiveness trial at 7 university-based and community hospitals in or near Pittsburgh, Pennsylvania. Participants were 302 post-CABG patients with depression (150, intervention; 152, usual care) and a comparison group of 151 randomly sampled post-CABG patients without depression recruited between March 2004 and September 2007 and observed as outpatients until June 2008.

Intervention: Eight months of telephone-delivered collaborative care provided by nurses working with patients' primary care physicians and supervised by a psychiatrist and primary care physician from this study.

Main outcome measures: Mental health-related quality of life (HRQL) measured by the Short Form-36 Mental Component Summary (SF-36 MCS) at 8-month follow-up; secondary outcome measures included assessment of mood symptoms (Hamilton Rating Scale for Depression [HRS-D]), physical HRQL (SF-36 PCS), and functional status (Duke Activity Status Index [DASI]); and hospital readmissions.

Results: The intervention patients reported greater improvements in mental HRQL (all P < or = .02) (SF-36 MCS: Delta, 3.2 points; 95% confidence interval [CI], 0.5-6.0), physical functioning (DASI: Delta, 4.6 points; 95% CI, 1.9-7.3), and mood symptoms (HRS-D: Delta, 3.1 points; 95% CI, 1.3-4.9); and were more likely to report a 50% or greater decline in HRS-D score from baseline (50.0% vs 29.6%; number needed to treat, 4.9 [95% CI, 3.2-10.4]) than usual care patients (P < .001). Men with depression were particularly likely to benefit from the intervention (SF-36 MCS: Delta, 5.7 points; 95% CI, 2.2-9.2; P = .001). However, the mean HRQL and physical functioning of intervention patients did not reach that of the nondepressed comparison group.

Conclusion: Compared with usual care, telephone-delivered collaborative care for treatment of post-CABG depression resulted in improved HRQL, physical functioning, and mood symptoms at 8-month follow-up.

Trial registration: clinicaltrials.gov Identifier: NCT00091962.

Figure 1. Flowchart of participants in the Trial

HIPAA, Health Insurance Portability and Accountability Act; PHQ-2, 2-item Patient Health Questionnaire; PHQ-9, 9-item Patient Health Questionnaire. Overall, 13% (60/453) did not complete their 8-month telephone assessment, and missed assessments for any reason did not differ by randomization or baseline depression status. Further inspection of the reasons for withdrawal among those depressed and randomized revealed they were mostly at these patients’ request or due to loss of follow-up contact.