Centralized, stepped, patient preference-based treatment for patients with post-acute coronary syndrome depression: CODIACS vanguard randomized controlled trial.

ABSTRACT: Controversy remains about whether depression can be successfully managed after acute coronary syndrome (ACS) and the costs and benefits of doing so.To determine the effects of providing post-ACS depression care on depressive symptoms and health care costs.Multicenter randomized controlled trial.Patients were recruited from 2 private and 5 academic ambulatory centers across the United States.A total of 150 patients with elevated depressive symptoms (Beck Depression Inventory [BDI] score ?10) 2 to 6 months after an ACS, recruited between March 18, 2010, and January 9, 2012.Patients were randomized to 6 months of centralized depression care (patient preference for problem-solving treatment given via telephone or the Internet, pharmacotherapy, both, or neither), stepped every 6 to 8 weeks (active treatment group; n = 73), or to locally determined depression care after physician notification about the patient's depressive symptoms (usual care group; n = 77).Change in depressive symptoms during 6 months and total health care costs.Depressive symptoms decreased significantly more in the active treatment group than in the usual care group (differential change between groups, -3.5 BDI points; 95% CI, -6.1 to -0.7; P = .01). Although mental health care estimated costs were higher for active treatment than for usual care, overall health care estimated costs were not significantly different (difference adjusting for confounding, -$325; 95% CI, -$2639 to $1989; P = .78).For patients with post-ACS depression, active treatment had a substantial beneficial effect on depressive symptoms. This kind of depression care is feasible, effective, and may be cost-neutral within 6 months; therefore, it should be tested in a large phase 3 pragmatic trial.clinicaltrials.gov Identifier: NCT01032018.

SUBMITTER: Davidson KW 

PROVIDER: S-EPMC3681929 | biostudies-literature | 2013 Jun

REPOSITORIES: biostudies-literature