Phone-based intervention effective for concurrent management of anxiety, depression in acute cardiac illness

Use of a telephone-based, low-intensity model to concurrently manage depression and anxiety disorders in patients hospitalized for an acute cardiac illness was associated with improved mental health-related quality of life at 24 weeks.

Researchers conducted a single blind trial of 183 adults admitted to a cardiac unit for ACS, arrhythmia disorders or HF between September 2010 and July 2013. All patients underwent structured assessment and were determined to have clinical depression (133 cases), generalized anxiety disorder (118 cases) and/or panic disorder (19 cases).

Patients were randomly assigned to a low-intensity, multicomponent collaborative care intervention for depression or anxiety (n=92) or usual care with serial notification of primary care providers (n=91) for 24 weeks. A social worker, in conjunction with a team of psychiatrists, managed the psychiatric care of the intervention recipients and provided therapeutic intervention when necessary. Patients in the collaborative-care group underwent follow-up via telephone within 2 weeks of discharge to evaluate symptoms and assess engagement and treatment adherence, with subsequent follow-up calls during the remainder of the study period.

The primary outcome was improvement in mental health-related quality of life at 24 weeks, as indicated by the Short Form-12 Mental Component Score. Secondary outcomes included assessment of depression, anxiety and functionality, as indicated by the PHQ-9, HADS-A and Duke Activity Status Index, respectively.

Quality of life scores were 34.21 in the collaborative-care group and 36.3 in the usual-care group at baseline. Patients in the collaborative care group opted to receive or adjust psychiatric medication in 78% of cases, undergo cognitive behavioral therapy in 12% of cases and declined both options in 10% of cases.

Among 172 patients with evaluable follow-up data, the collaborative-care group had greater mean improvements in their quality of life scores at 24 weeks (11.21-point improvement vs. 5.53-point improvement; P=.002). This improvement was not impacted by gender (P=.72) or psychiatric diagnosis (P=.44). Patients in the collaborative-care group also experienced significant improvement in general functioning (P=.005) and symptoms of depression (P=.045). The two groups did not differ with regard to changes to anxiety scores, rates of disorder response or adherence to treatment at 24 months.

“Adequately powered and randomized trials remain necessary to determine whether refinements to this model … can lead to even greater improvements in mental health and function,” the researchers wrote. “Given the relatively low-burden and low-resource nature of this intervention — with telephone delivery of all post-discharge interventions and use of a single social worker as the [care manager] for three psychiatric illnesses — such a program may be easily implemented and effective in real-world settings.”

Jonathan A. Shaffer

According to Karina W. Davidson, PhD, Ian M. Kronish, MD, MPH, and Jonathan A. Shaffer, PhD, of the Center for Behavioral Cardiovascular Health at Columbia University, this trial was unusual for combining patients with different illnesses and psychiatric diagnoses together, and assessing the impact of a single treatment on multiple risk factors simultaneously, they wrote in a related commentary.

“Lumping together co-occurring risk factors, conditions, patient groups and management strategies, particularly when one treatment may be an appropriate solution for many problems, may mark a new wave of science that emerges from our changing medical care reimbursement landscape,” they wrote.

For more information:

Huffman JC. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.739.

Davidson KW. JAMA Intern Med. 2014; doi:10.1001/jamainternmed.2014.86.

Disclosure: One researcher reports receiving an honorarium from the American Physician Institute for Advanced Professional Studies for a presentation on depression in patients with heart conditions. Davidson, Kronish and Shaffer report no relevant financial disclosures.