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Treatment of depression after coronary artery bypass surgery: a randomized controlled trial.

ABSTRACT: There has been little research on the treatment of depression after coronary artery bypass surgery.To test the efficacy of 2 nonpharmacological interventions for depression after coronary artery bypass surgery compared with usual care.A 12-week, randomized, single-blind clinical trial with outcome evaluations at 3, 6, and 9 months.Outpatient research clinic at Washington University School of Medicine, St Louis, Missouri.One hundred twenty-three patients who met the DSM-IV criteria for major or minor depression within 1 year after surgery.Twelve weeks of cognitive behavior therapy or supportive stress management. Approximately half of the participants were taking nonstudy antidepressant medications.Remission of depression, defined as a score of less than 7 on the 17-item Hamilton Rating Scale for Depression.Remission of depression occurred by 3 months in a higher proportion of patients in the cognitive behavior therapy (71%) and supportive stress-management (57%) arms than in the usual care group (33%) (chi(2)(2) = 12.22, P = .002). Covariate-adjusted Hamilton scores were lower in the cognitive behavior therapy (mean [standard error], 5.5 [1.0]) and the supportive stress-management (7.8 [1.0]) arms than in the usual care arm (10.7 [1.0]) at 3 months. The differences narrowed at 6 months, but the remission rates differed again at 9 months (73%, 57%, and 35%, respectively; chi(2)(2) = 12.02, P = .003). Cognitive behavior therapy was superior to usual care at most points on secondary measures of depression, anxiety, hopelessness, stress, and quality of life. Supportive stress management was superior to usual care only on some of the measures.Both cognitive behavior therapy and supportive stress management are efficacious for treating depression after coronary artery bypass surgery, relative to usual care. Cognitive behavior therapy had greater and more durable effects than supportive stress management on depression and several secondary psychological outcomes.clinicaltrials.gov Identifier: NCT00042198.

SUBMITTER: Freedland KE

PROVIDER: S-EPMC5550769 | biostudies-literature | 2009 Apr

REPOSITORIES: biostudies-literature

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Treatment of depression after coronary artery bypass surgery: a randomized controlled trial.

Freedland Kenneth E KE Skala Judith A JA Carney Robert M RM Rubin Eugene H EH Lustman Patrick J PJ Dávila-Román Victor G VG Steinmeyer Brian C BC Hogue Charles W CW

Archives of general psychiatry 20090401 4

<h4>Context</h4>There has been little research on the treatment of depression after coronary artery bypass surgery.<h4>Objective</h4>To test the efficacy of 2 nonpharmacological interventions for depression after coronary artery bypass surgery compared with usual care.<h4>Design</h4>A 12-week, randomized, single-blind clinical trial with outcome evaluations at 3, 6, and 9 months.<h4>Setting</h4>Outpatient research clinic at Washington University School of Medicine, St Louis, Missouri.<h4>Patient ...[more]

PMID: 19349308

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Project description:In coronary artery bypass grafting surgery, arterial conduits are preferred because of more favourable long-term patency and outcome. Anyway the greater saphenous vein continues to be the most commonly used bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is increasingly being investigated in order to reduce the morbidity associated with conventional open vein harvesting, includes postoperative leg wound complications, pain and patient satisfaction. However, to date the short and the long-term benefits of the endoscopic technique remain controversial. This study provides an interesting opportunity to address this gap in the literature.Endoscopic Saphenous harvesting with an Open CO2 System trial includes two parallel vein harvesting arms in coronary artery bypass grafting surgery. It is an interventional, single centre, prospective, randomized, safety/efficacy, cost/effectiveness study, in adult patients with elective planned and first isolated coronary artery disease. A simple size of 100 patients for each arm will be required to achieve 80% statistical power, with a significant level of 0.05, for detecting most of the formulated hypotheses. A six-weeks leg wound complications rate was assumed to be 20% in the conventional arm and less of 4% in the endoscopic arm. Previously quoted studies suggest a first-year vein-graft failure rate of about 20% with an annual occlusion rate of 1% to 2% in the first six years, with practically no difference between the endoscopic and conventional approaches. Similarly, the results on event-free survival rates for the two arms have barely a 2-3% gap. Assuming a 10% drop-out rate and a 5% cross-over rate, the goal is to enrol 230 patients from a single Italian cardiac surgery centre.The goal of this prospective randomized trial is to compare and to test improvement in wound healing, quality of life, safety/efficacy, cost-effectiveness, short and long-term outcomes and vein-graft patency after endoscopic open CO2 harvesting system versus conventional vein harvesting.The expected results are of high clinical relevance and will show the safety/efficacy or non-inferiority of one treatment approach in terms of vein harvesting for coronary artery bypass grafting surgery.www.clinicalTrials.gov NCT01121341.

Project description:BackgroundAlthough early ambulation (EA) is associated with improved outcomes in post-operative patients, implementation of EA in elderly patients is still a challenge. In this study, we aimed to design and assess a precision early ambulation program for cardiac rehabilitation.MethodsWe conducted a single-center, randomized and controlled clinical trial in elderly patients aged over 60 years after off-pump coronary artery bypass graft (OPCABG) surgery. Patients were randomly assigned to a precision early ambulation (PEA) group or a routine ambulation (Control) group. Age-predicted maximal heart rate (APMHR) and maximal oxygen uptake (VO2max) were used as a reference to formulate and monitor the PEA regimen. The primary end-point was the postoperative length of stay in hospital (PLOS). The secondary end-points included 90-day mortality, incidence of early discharge, laboratory tests, length of ICU stay, the incidence of multiple organ complications and post-traumatic stress disorder (PTSD). Ambulation outcomes were also recorded.ResultsIn total, 178 patients were enrolled (n = 89 per group). In the intent-to-treat analysis, PLOS in the PEA group was shorter than that in the Control group (9.04 ± 3.08 versus 10.09 ± 3.32 days, respectively. Mean difference 1.045 days; 95% confidence interval [CI] 0.098-1.992; P = 0.031 in the unadjusted model; mean difference 0.957 days; CI 0.007-1.907; P = 0.048 in adjusted model). The incidence of early discharge differed significantly between the PEA and control groups (41[46.1%] versus 24[27.0%] patients, respectively. Odds ratio [OR] 0.432; CI 0.231-0.809; P = 0.009 in unadjusted model; OR 0.466; CI 0.244-0.889, P = 0.02 in adjusted model). The time of first bowel movement, partial pressure O2 and post-traumatic stress disorder score in the PEA group were better than those in the Control group. Participants walked much longer distances on day 3 in the PEA group than those in the Control group (76.12 ± 29.02 versus 56.80 ± 24.40 m, respectively, P < 0.001).ConclusionAPMHR and VO2max are valuable for implementation of PEA according to an established security threshold. PEA after OPCAPG surgery is safe and reliable for elderly patients, not only reducing the hospital stay, but also improving their physiological and psychological symptoms.Trial registrationThis study is a component of a protocol retrospectively registered: Application of ERAS in cardiovascular surgery.Trial registration numberChiCTR1800018167 . Date of registration: 3rd September, 2018. URL of trial registry record: http://www.chictr.org.cn/index.aspx.

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Treatment of depression after coronary artery bypass surgery: a randomized controlled trial.

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Treatment of depression after coronary artery bypass surgery: a randomized controlled trial.

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