The effect of enhanced depression care on adherence to risk-reducing behaviors after acute coronary syndromes: findings from the COPES trial

Am Heart J. 2012 Oct;164(4):524-9. doi: 10.1016/j.ahj.2012.07.024.


Background: The presence of depression after an acute coronary syndrome (ACS) is associated with worse prognosis and lower adherence to risk-reducing behaviors. We reported earlier that an enhanced depression care intervention reduces depression symptoms and major adverse cardiac events. This study evaluates the impact of the depression intervention on health behavior and blood pressure control.

Methods: Between 2005 and 2008, 157 patients who remained persistently depressed 3 months after ACS were randomized to a 6-month depression intervention (initial patient preference for problem-solving therapy and/or pharmacotherapy, followed by stepped care; 80 patients) or to usual care (77 patients). At randomization, and then 2, 4, and 6 months later, patients were asked if they (1) missed taking their aspirin; (2) followed a heart healthy diet; (3) exercised regularly; and (4) used tobacco products. Blood pressure was measured before randomization and 6 months later.

Results: At the end of the intervention, there was no significant improvement in the percentage of intervention compared to control group patients who adhered to aspirin (+3% versus -1%, P = .23), followed a healthy diet (+10% versus +8%, P = .39), exercised regularly (+5% versus +4%, P = .65), abstained from tobacco (-3% versus -1%, P = .77), or had controlled blood pressure (+6% versus +16%, P = .26).

Conclusion: Despite improving depression, enhanced depression care after an ACS did not improve health behavior or blood pressure control compared to usual care. Research is needed to test whether adding an adherence intervention to enhanced depression care can improve adherence and cardiovascular prognosis in depressed patients post-ACS.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / prevention & control
  • Acute Coronary Syndrome / psychology*
  • Antidepressive Agents / therapeutic use*
  • Aspirin / therapeutic use
  • Depression / etiology
  • Depression / therapy*
  • Diet
  • Exercise
  • Female
  • Humans
  • Hypertension / therapy
  • Male
  • Middle Aged
  • Patient Compliance / psychology*
  • Problem Solving*
  • Psychotherapy / methods
  • Risk Reduction Behavior*
  • Smoking Prevention


  • Antidepressive Agents
  • Aspirin