ACS and Depression: Patient Preference Matters

Acute coronary syndrome patients who received treatment for depression had fewer depressive symptoms than those in a usual-care group, according to the results of a study.

Heart disease and depression go hand-in-hand for more than half of all acute coronary syndrome (ACS) patients. Experts still debate whether treating post-ACS depression aggressively improves patient outcomes and whether treatment has positive effects on the overall cost of care.

According to the results of a multicenter randomized controlled trial published online on March 7, 2013, in JAMA Internal Medicine, designing depression care programs that respect patient preference decreases symptoms in post-ACS patients.

Researchers at New York City’s Columbia University worked with colleagues at 2 private and 5 academic ambulatory centers across the United States. They randomized 150 patients with scores of 10 or more on the Beck Depression Inventory (BDI) 2 to 6 months after an ACS episode. The active-treatment group received 6 months of centralized depression care. Patients were allowed to express a preference for problem-solving treatment (delivered via telephone or the Internet), pharmacotherapy, both, or neither. Care was adjusted to meet patients’ changing needs every 6 to 8 weeks. The usual-care group received locally determined depression care after physician notification about the patient's depressive symptoms.

After 6 months, patients in the active-treatment group had fewer depressive symptoms than those in the usual-care group (differential change between groups, −3.5 BDI points). Mental health care costs were higher in the active treatment group, but overall care costs for both groups were not significantly different. Patients who didn’t receive mental health care received more medical care. This indicates that patient preference—driven care confers general health benefits as well as mental health benefits.

“This kind of depression care is feasible, effective, and may be cost-neutral within 6 months; therefore, it should be tested in a large phase 3 pragmatic trial,” the researchers concluded.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.