Abstract 16731: Interaction between Cognitive Behavioral Therapy and Ejection Fraction in Depressed Cardiac Surgery Patients

Abstract

Background: Cognitive behavioral therapy (CBT) is an effective treatment option for depression, but few studies have examined its effect on cardiac surgery (CS) patients with low ejection fraction (EF). Objective: To evaluate the relationship of EF and depressive symptoms in depressed patients assigned to nurse-guided cognitive behavioral therapy (CBT) or usual care (UC) after CS.

Methods: Using the Beck Depression Inventory (BDI), we screened 808 patients for depressive symptoms within 1 month of hospital discharge after CS. Patients who met criteria for clinical depression (n = 81, 31% female, 31% minority, age 63 ± 9.8 years, 17% EF < 40%) were randomized to 8 weeks of CBT or UC. After 8 weeks, depressive symptoms were re-measured. Medical charts were reviewed for clinical variables including preoperative EF, medications, and comorbidities. Four patients with missing EF data were excluded. Controlling for age, repeated measures ANOVA was used to measure change in depressive symptoms over time by treatment group and EF status.

Results: The CBT group showed greater improvement in depressive symptoms over time compared to the UC group (p<0.001). There was a significant interaction effect among time, treatment group and EF status (p = 0.03). In patients with normal EF (≥ 40), mean BDI scores in the UC group increased by 4.7% (indicating worsening symptoms), while mean BDI scores in the CBT group decreased (indicating symptom improvement) by 35.1% (p = .027). In patients with low EF (< 40%), mean BDI scores worsened by 36.8% and improved by 69.2% in the UC and CBT groups, respectively (p = .004). The interaction was also significant when cognitive/affective symptoms (p=.01) and somatic symptoms (p=.04) were considered separately (Figure).

Conclusions: Nurse-guided CBT is effective in reducing depressive symptoms after CS and may be particularly effective in patients with low EF. Larger clinical trials of CBT in CS patients with low EF are needed to confirm these findings.