Collaborative care model improved quality-of-life, depression in CABG patients

American Heart Association Scientific Sessions 2009

A telephone-based collaborative care model increased recovery time in patients who underwent CABG and improved mental and physical health outcomes, according to data from the Bypassing the Blues trial.

“This is the first study to utilize a collaborative care model to treat depression following an acute cardiac event,”Bruce Rollman, MD, MPH, of the University of Pittsburgh, said during a press conference.

A team of nurses utilized the Patient Health Questionnaire to screen 2,485 patients for depression who underwent CABG at one of seven Pittsburgh-area hospitals.

Researchers then randomly assigned 302 depressed patients to either a “usual care” group or a collaborative care group for eight months in comparison with a subset of 151 non-depressed patients who underwent CABG.

Treatment options for the collaborative care model included a self-help workbook, antidepressant pharmacotherapy and/or referral to a community mental health specialist. Patients who chose to see a specialist or pursue medication paid for it out-of-pocket.

The researchers used the Duke Activity Status Index to assess physical functioning, SF-36 questionnaire to assess mental and physical health and the Hamilton Rating Scale to assess mood symptoms.

At baseline, patients who were depressed had significantly worse scores for all areas when compared with non-depressed patients. At eight months follow-up, patients who received collaborative care had significant improvements in all scores when compared with patients who received usual care.

Depressed patients were more likely to report 50% or more decline in adverse mood symptoms (50% vs. 29.6%; %; P<.001) — this was particularly true for men (60.5% vs. 33.3%; P<.001).

Further, men had a lower likelihood for re-hospitalization from CVD causes at eight months when compared with men who were depressed assigned to usual care (13% vs. 23%; P=.07).

“We were able to demonstrate that our intervention significantly improved quality of life and reduced adverse symptoms as early as two months following surgery as well as reduced re-hospitalization in depressed men at eight months,” Rollman said. – by Jennifer Southall

Rollman B. LBCT.03. Presented at: the American Heart Association 2009 Scientific Session; Nov. 14-18, 2009; Orlando, Fla.

Depression following a major cardiac surgery is a common problem. This study was well designed and demonstrated that relatively minor interventions can add a significant nature to quality of life and mood changes to patients who undergo CABG as well as reduced re-hospitalizations in the male population. However, this is not the final answer as it did not address all issues. But it does add a lot to our knowledge of the care for patients following bypass surgery.

– Frank W. Sellke, MD

Chief, division of cardiothoracic surgery

Alpert Medical School of Brown University