Depression is highly prevalent among patients following coronary artery bypass graft (CABG) surgery and is associated with reduced health-related quality of life (HRQoL) and increased cardiovascular morbidity and mortality. Since depression is a treatable determinant of HRQoL, evidence-based treatment for post-CABG depression provided in a primary care setting and using proven effective dissemination methods is a novel approach to improve outcomes and potentially reduce health care costs. We will recruit 300 patients who endorse elevated levels of depressive symptoms at both 3-5 days following CABG surgery and when reassessed 2-weeks after hospital discharge. We will randomize these patients to receive either: (1) their physicians' """"""""usual care"""""""" for depression; or (2) a stepped collaborative care program involving a telephone based nurse care manager who will contact patients at regular intervals to assess treatment preferences for depression (counseling, self-management workbook, pharmacotherapy, or specialty referral); promote adherence with care; and monitor the therapeutic response in concert with patients' POPs and under the supervision of a study clinician. We will also randomly select 150 non-depressed post-CABG patients to serve as a control cohort to facilitate comparisons with our depressed patients on various baseline and follow-up measures, and to better understand the benefits derived from depression treatment (total N=450). We will conduct blinded telephone assessments at 2-, 4-, 8-, and 12-months post-CABG and then every six months until the Last study patient completes his/her 8-month assessment (range: 8-44 months follow-up). We will use intent-to-treat analyses to test our primary hypothesis that our intervention will produce at least a clinically meaningful 0.5 effect size improvement in HRQoL at 8-months post-CABG, as measured by the SF-36 Mental Component Summary score, compared to patients who receive their POPs' """"""""usual care"""""""" for depression. Our secondary hypotheses are that compared to """"""""usual care"""""""" patients, intervention patients will: (1) experience higher levels of functional status, and lower levels of depressive symptoms, risk for future cardiovascular events, and health services costs; and (2) report similar levels of HRQoL as non-depressed post-CABG patients. ? Providing evidence-based stepped collaborative care treatment for post-CABG depression may be an ideal method for organized health care delivery systems to improve outcomes. Our focus on HRQoL and on health services costs will facilitate comparisons of the benefits derived from our intervention to that of other established treatments of cardiovascular risk factors and care for other chronic conditions. This study will enhance our understanding of the impact and course of post-CABG depression. ? ?

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL070000-04
Application #
7070506
Study Section
Special Emphasis Panel (ZRG1-RPHB-2 (01))
Program Officer
Czajkowski, Susan
Project Start
2003-08-24
Project End
2008-06-30
Budget Start
2006-07-01
Budget End
2007-06-30
Support Year
4
Fiscal Year
2006
Total Cost
$1,192,794
Indirect Cost
Name
University of Pittsburgh
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
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Tindle, Hilary; Belnap, Bea Herbeck; Houck, Patricia R et al. (2012) Optimism, response to treatment of depression, and rehospitalization after coronary artery bypass graft surgery. Psychosom Med 74:200-7
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Schulberg, Herbert C; Belnap, Bea Herbeck; Houck, Patricia R et al. (2011) Treating post-CABG depression with telephone-delivered collaborative care: does patient age affect treatment and outcome? Am J Geriatr Psychiatry 19:871-80
Morone, Natalia E; Weiner, Debra K; Belnap, Bea Herbeck et al. (2010) The impact of pain and depression on recovery after coronary artery bypass grafting. Psychosom Med 72:620-5
Rollman, Bruce L; Belnap, Bea Herbeck; LeMenager, Michelle S et al. (2009) Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial. JAMA 302:2095-103
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