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Telephone-based care model improved QOL in cardiac patients with depression
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A low-intensity, telephone-based approach to managing cardiac and mental health issues improved mental health-related quality of life in patients with CVD and depression or anxiety disorders in a recent study.
In a single blind, randomized, 24-week clinical trial, researchers assessed 183 patients admitted for acute cardiac illness, HF or arrhythmia to one of three cardiac units in an urban academic medical center. All patients were also diagnosed with clinical depression (n=133), generalized anxiety disorder (n=118) or panic disorder (n=19). The researchers randomly assigned patients to a telephone-based collaborative care model of management (n=92) or enhanced usual care (n=91), with evaluable follow-up data obtained for 172 participants.
Patients in the collaborative care group were managed by a part-time social work care manager in tandem with team psychiatrists. The care manager and patients developed a plan for telephone-delivered cognitive behavioral therapy specific to the patient’s condition, along with appropriate pharmacotherapy if preferred. Within 2 weeks of hospital discharge, patients in this group participated in a 15- to 30-minute follow-up call with the care manager to discuss their symptoms and treatment adherence and effects. Subsequent calls were scheduled at varying time points according to the patient’s condition and treatment plan.
In the enhanced usual care group, the care manager informed the patients’ inpatient management team of their depression or anxiety diagnosis, and advised the team of the potential benefits of treatment. At each 6-week follow-up evaluation, letters were sent to the primary treatment providers of patients with continued symptoms of anxiety or depression notifying them of the patients’ condition, for a total of up to five contacts during the study. The primary outcome measure was improvement to mental health-related QOL, as indicated by the Short Form-12 Mental Component Score (SF-12 MCS) at 24 weeks.
Within the collaborative care group, 78% of patients elected to initiate or adjust their psychiatric medication, whereas 12% selected cognitive behavioral therapy. Patients in this group exhibited significantly higher mean improvements to SF-12 MCS scores at 24 weeks than the usual care group (11.21-point improvement vs. 5.53 points; P=.002). The result was not affected by sex or psychiatric diagnosis. Collaborative care group patients also demonstrated significant improvements to depressive symptoms and overall functioning, as well as higher rates of receiving treatment for a mental health disorder, and were more likely to have received adequate treatment for at least one psychiatric disorder by discharge (75% of patients vs. 7%; P<.001).
There were no significant differences between the groups with regard to 24-week anxiety scores, prevalence of depression or anxiety response to treatment, physical health-related QOL or patient compliance with treatment regimens.
The researchers concluded that larger randomized trials are needed to determine whether modifications to the collaborative care strategy, such as increased post-discharge interaction, might improve results from this approach.
“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,” the researchers wrote.
Disclosure: One researcher reported receiving an honorarium from the American Physician Institute for Advanced Professional Studies for a presentation on depression in patients with heart conditions.
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