Abstract 1306: Enhanced Depression Care for Acute Coronary Syndrome Patients With Persistent Depression: A Randomized Controlled Trial
Context: Depression is an established predictor of mortality and major adverse cardiac events (MACE) acute coronary syndrome (ACS) patients.
Objective: To determine effect of enhanced depression treatment in ACS patients.
Design, Setting, and Patients: Three-month observation period to identify ACS patients with persistent depressive symptoms, followed by a 6-month randomized controlled trial. 237 ACS patients were enrolled: 157 persistently depressed patients were randomized into trial and 80 nondepressed were followed observationally.
Intervention: Patients randomized to intervention (Enhanced care n=80: patient preference for problem-solving therapy and/or pharmacotherapy) or Usual care (n=77).
Main Outcome Measures: Outcomes were patient satisfaction with depression care, depressive symptom changes, assessed by Beck Depression Inventory (BDI), and MACE (nonfatal myocardial infarction, unstable angina hospitalization) or death.
Results: Proportion of intervention patients satisfied with their depression care was higher (54%) than in the usual care group (18%); (odds ratio, 5.4; 95% confidence interval [CI], 2.2–12.9; P<.001). Intervention patients had significantly fewer depressive symptoms (change, −5.7; 95% CI, −7.6 to −3.8) than usual care patients (change, −1.9; 95% CI, −3.8 to −0.1); the differential change between groups was also significant (t=2.85, P=.005) for an effect size of .59. Three intervention patients and 10 usual care patients had MACE (4% and 13%, respectively; log-rank test χ2=3.78; P=.05); nondepressed had 5 MACE (6%).
Conclusions: The intervention resulted in fewer depressive symptoms and greater improvement in prognosis.