Bypassing the blues: Telephone treatment for depression post-bypass surgery improves quality of life

Study findings, to be published in the Nov. 18 edition of the Journal of the American Medical Association (JAMA), also will be presented in a late-breaking clinical trials plenary session at the American Heart Association (AHA) Annual Meeting at 6 p.m. EST, Nov. 16, in Orlando, Fla.

With more than 450,000 procedures performed annually, CABG surgery is one of the most frequently performed and costly medical procedures in the United States. Although the procedure clearly benefits many individuals, 20 to 25 percent experience depressive symptoms following CABG surgery. Those with depressive symptoms have worse clinical outcomes, including poorer quality of life, continued chest pains and a higher risk of re-hospitalization and death.

"Bypassing the Blues" is the first trial to examine the impact of a collaborative care strategy for treating depression following an acute cardiac event. The intervention included weekly telephone follow-up by a nurse using an evidence-based treatment protocol for depression. The nurse collaborated with the patients' primary care physicians and the study's clinical management team, composed of a psychiatrist, psychologist and internist. This approach has proven effective for treating major depression in primary care settings but had never before been applied to a population with cardiac disease.

"Dozens of studies have described a link between depression and heart disease, and the most recent science advisory from the American Heart Association recommends screening patients with heart disease for depression," said Bruce Rollman, M.D., M.P.H., associate professor of medicine and psychiatry, Center for Research on Health Care, University of Pittsburgh School of Medicine, and the study's principal investigator. "However, few depression treatment trials have involved cardiac patients and none used the collaborative care model or examined the impact of treating post-CABG depression on quality of life, re-hospitalizations or health care costs, as we did."

Investigators recruited 453 post-CABG patients from seven Pittsburgh-area hospitals, from 2004 through 2007. They included 302 depressed patients who were randomly assigned to either an eight-month course of telephone-delivered collaborative care or to their doctors' usual care for depression. Investigators also randomly sampled an additional 151 non-depressed, post-CABG patients to facilitate comparisons to depressed patients. They tracked these patients to monitor quality of life, physical functioning, mood symptoms, re-hospitalizations, health care costs and deaths.

The researchers found that intervention patients reported greater improvements in mental health- related quality of life, physical functioning and mood symptoms. Overall, 50 percent of intervention patients reported a 50 percent or greater reduction in mood symptoms from baseline to eight-month follow-up versus 29.6 percent of patients in usual care. "Men with depression were particularly likely to benefit from the intervention. However, the mean health-related quality of life and physical functioning of intervention patients did not reach that of the non-depressed comparison group," said Dr. Rollman.

Co-authors of the study include Bea Herbeck Belnap, senior research associate, Department of Medicine, Wishwa N. Kapoor, M.D., M.P.H., professor of medicine, Division of General Internal Medicine, and director, Center for Research on Health Care, Charles F. Reynolds III, M.D., professor of psychiatry, Western Psychiatric Institute and Clinic of UPMC, Sati Mazumdar, Ph.D., professor of biostatistics, Graduate School of Public Health, Patricia Houck, M.D., statistical services administrator, Graduate School of Public Health, and Peter Counihan, M.D., associate professor of medicine, Cardiovascular Institute, all of the University of Pittsburgh; and Herbert C. Schulberg, Ph.D., psychiatry, Weill Cornell Medical School, and professor emeritus of psychiatry at the University of Pittsburgh.

The Bypassing the Blues trial is funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

For more information, visit the study's Web site at www.bypassingtheblues.pitt.edu.