A Collaborative Care Program to Improve Depression Treatment in Cardiac Patients

Mass General Brigham

Status: Completed

Conditions: Coronary Artery Disease; Arrhythmia; Depression; Congestive Heart Failure

Treatments: Behavioral: Collaborative Care Treatment; Behavioral: Usual Care Treatment

Study type: Interventional

Funder types: Other

Identifiers

NCT00847132

2007P-001152

Details and patient eligibility

About

Depression in cardiac patients is common, persistent, and deadly. However, the vast majority of cardiac patients with depression go unrecognized and untreated, despite the existence of treatments that clearly improve depressive symptoms and may favorably impact survival. Our research group and others have found that depression recognition and treatment appears particularly limited among patients with acute cardiac illness, though this population may be the most vulnerable to the deleterious effects of depression. We propose a project, building on successful collaborative care depression management programs in outpatient settings, to address this important issue.

The specific hypotheses behind the proposed research are that a collaborative care depression management program can be successfully adapted to inpatient cardiac units, and that such a program will lead to greater rates of adequate depression treatment and improvements in secondary outcomes.

The following specific aims capture the stepwise goals of this program:

1. To determine whether a collaborative care depression management program ('Enhanced Care') leads to significantly increased rates of adequate depression treatment compared to usual care (screening and feedback) (Primary Aim).
2. To assess whether this Enhanced Care program has a lasting impact on adequate depression treatment, depressive symptoms, health-related quality of life, and adherence to medical recommendations at 6 weeks, 12 weeks, and 6 months, compared to usual care.

Enrollment: 175 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Inpatient admission for cardiac diagnosis
• Positive depression evaluation (PHQ-2>2, PHQ-9>9)
• Ability to provide informed consent

Exclusion criteria

• Active suicidal ideation
• Bipolar disorder, psychotic disorder, active substance use disorder

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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175 participants in 2 patient groups

Collaborative Care

Experimental group

Description:

Collaborative Care Treatment: A study care manager provides depression education, consults with study psychiatrist to develop individualized treatment recommendations, and collaborates with patient and medical team to implement those recommendations

Treatment:

Behavioral: Collaborative Care Treatment

Usual Care

Active Comparator group

Description:

Usual Care Treatment: Primary medical providers are informed that the patient has depression and that treatment is recommended.

Treatment:

Behavioral: Usual Care Treatment