Depression is a common diagnosis associated with heart disease and a dangerous sequel after cardiac surgery. A new study finds that telemedicine consultations can reduce depression and improve quality of life after a coronary artery bypass graft (CABG).
Although experts have known that depressive symptoms are associated with poor clinical outcomes after cardiac surgery, successful intervention to resolve or improve the situation has remained elusive.
The new initiative, “Bypassing the Blues,” included weekly telephone followup by a nurse using an evidence-based treatment protocol for depression.
The nurse collaborated with the patients’ primary care physicians and the study’s clinical management team, composed of a psychiatrist, psychologist and internist.
This approach has proven effective for treating major depression in primary care settings but had never before been applied to a population with cardiac disease.
“Dozens of studies have described a link between depression and heart disease, and the most recent science advisory from the American Heart Association recommends screening patients with heart disease for depression,” said Bruce Rollman, M.D., M.P.H., associate professor of medicine and psychiatry, Center for Research on Health Care, University of Pittsburgh School of Medicine, and the study’s principal investigator.
“However, few depression treatment trials have involved cardiac patients and none used the collaborative care model or examined the impact of treating post-CABG depression on quality of life, re-hospitalizations or health care costs, as we did.”
Investigators recruited 453 post-CABG patients from seven Pittsburgh-area hospitals, from 2004 through 2007. They included 302 depressed patients who were randomly assigned to either an eight-month course of telephone-delivered collaborative care or to their doctors’ usual care for depression.
Investigators also randomly sampled an additional 151 non-depressed, post-CABG patients to facilitate comparisons to depressed patients. They tracked these patients to monitor quality of life, physical functioning, mood symptoms, re-hospitalizations, health care costs and deaths.
The researchers found that intervention patients reported greater improvements in mental health-related quality of life, physical functioning and mood symptoms. Overall, 50 percent of intervention patients reported a 50 percent or greater reduction in mood symptoms from baseline to eight-month followup versus 29.6 percent of patients in usual care.
“Men with depression were particularly likely to benefit from the intervention. However, the mean health-related quality of life and physical functioning of intervention patients did not reach that of the non-depressed comparison group,” said Dr. Rollman.
Study findings are presented in the current edition of the Journal of the American Medical Association .