Psychological and pharmacological interventions for depression in patients with coronary artery disease

Baumeister, Harald; Hutter, Nico; Bengel, Jürgen

doi:10.1002/14651858.cd008012.pub3

Cited by 141 publications

(84 citation statements)

References 94 publications

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“…96 Our data suggest that more nurse time was associated with improved outcomes, so more intensive follow-up should be included in future use of the PC intervention.…”

Section: Discussionmentioning

confidence: 69%

“…The fact that only a small improvement in depression symptoms was found over the entire sample is consistent with systematic review evidence indicating that even intensive evidence-based psychological treatments, such as CBT, problem-solving and pharmacological intervention with selective serotonin reuptake inhibitors, have only a small effect on depression in people with CHD. 96,136 Furthermore, our sample appears to represent a hard-to-treat group: the level of depression symptoms was high, more than half reported recurrent depression and more than one-quarter reported that they were receiving depression treatment at baseline and yet still reported depression symptoms. In addition, a large longitudinal cohort study (n = 1209) 137 has found that pain, mediated by baseline severity of mood symptoms, was predictive of a worse course of depressive and anxiety disorders; all of our participants reported current chest pain, which was an inclusion criterion.…”

Section: Implications Of Clinical Findings For a Future Trial Of Persmentioning

confidence: 93%

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UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

Tylee

Barley

Walters

et al. 2016

Programme Grants Appl Res

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BackgroundDepression is common in patients with coronary heart disease (CHD) but the relationship is uncertain. In the UK, general practitioners (GPs) have been remunerated for finding depression in CHD patients; however, it is unclear how to manage these patients.ObjectivesOur aim was to explore the relationship between CHD and depression in a GP population and to develop nurse-led personalised care (PC) for patients with CHD and depression.DesignThe UPBEAT-UK study consisted of four related studies. A cohort study of patients from CHD registers to explore the relationship between CHD and depression. A metasynthesis of relevant literature and two qualitative studies [patients’ perspectives and GP/practice nurse (PN) views on management of CHD and depression] helped develop an intervention. A pilot randomised controlled trial (RCT) of PC was conducted.SettingThirty-three GP surgeries in south London.ParticipantsAdult patients on GP CHD registers.InterventionsFrom the qualitative studies, we developed nurse-led PC, combining case management and self-management theory. Following biopsychosocial assessment, a PC plan was devised for each patient with chest pain and depressive symptoms. Nurses helped patients address their most important related problems. Use of existing resources was promoted. Nurse time was conserved through telephone follow-up.Main outcome measuresThe main outcome of the pilot study of our newly developed PC for people with depression and CHD was to assess the acceptability and feasibility of the intervention and to decide on the best outcome measures. Depression, measured by the Hospital Anxiety and Depression Scale – depression subscale, and chest pain, measured by the Rose angina questionnaire, were the main outcome measures for the feasibility and cohort studies. Cardiac outcomes in the cohort study included: attendance at rapid access chest pain clinics, stent insertion, bypass graft surgery, myocardial infarction and cardiovascular death. Service use and costs were measured and linked to quality-adjusted life-years (QALYs). Data for the pilot RCT were obtained by research assistants from patient interviews at baseline, 1, 6 and 12 months for the pilot RCT and at baseline and 6-monthly interviews for up to 36 months for the cohort study, using standard questionnaires.ResultsPersonalised care was acceptable to patients and proved feasible. The reporting of chest pain in the intervention group was half that of the control group at 6 months, and this reduction was maintained at 1 year. There was also a small improvement in self-efficacy measures in the intervention group at 12 months. Anxiety was more prevalent than depression in our CHD cohort over the 3 years. Nearly half of the cohort complained of chest pain at outset, with two-thirds of these being suggestive of angina. Baseline exertional chest pain (suggestive of angina), anxiety and depression were independent predictors of adverse cardiac outcome. Psychosocial factors predicted the continued reporting of exertional chest pain across the 3 years of follow-up. Costs were slightly lower for the PC group but QALYs were also lower. Neither difference was statistically significant.ConclusionsChest pain, anxiety, depression and social problems are common in patients on CHD registers in primary care and predict adverse cardiac outcomes. Together they pose a complex management problem for GPs and PNs. Our pilot trial of PC suggests a promising approach for treatment of these patients. Generalisation is limited because of the selection bias in recruitment of the practices and the subsequent participation rate of the CHD register patients, and the fact that the research took place in south London boroughs. Future work should explicitly explore methods for effective implementation of the intervention, including staff training needs and changes to practice.Trial registrationCurrent Controlled Trials ISRCTN21615909.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 8. See the NIHR Journals Library website for further project information.

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“…96 Our data suggest that more nurse time was associated with improved outcomes, so more intensive follow-up should be included in future use of the PC intervention.…”

Section: Discussionmentioning

confidence: 69%

Section: Implications Of Clinical Findings For a Future Trial Of Persmentioning

confidence: 93%

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

Tylee

Barley

Walters

et al. 2016

Programme Grants Appl Res

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“…There is no current evidence that antidepressant treatment improves CVD. It may be effective in the reduction of depression and may improve patient quality of life [45][46][47], but does not reduce the risk of death or serious cardiac events [48]. Most antidepressants proved to be safe in patients with CVD and HF and, if necessary, may be used to treat depression (with some exceptions), to improve the symptoms of the patient, and reduce patient suffering.…”

Section: Discussionmentioning

confidence: 99%

Depression and anxiety in cardiovascular disease

Małyszczak¹,

Rymaszewska²

2016

Kardiol Pol

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Associate Professor Krzysztof Małyszczak is a head of the Division of Psychotherapy and Psychosomatic Medicine at the Department of Psychiatry, Wroclaw Medical University. He is a psychiatrist and a psychotherapy supervisor, the organiser and chief specialist in a ward for the treatment of neuroses and personality disorders. His projects are focused on mood, anxiety, and personality disorders, especially in cases coexistence of somatic diseases. He participated in a study of factors affecting depression in cancer and hepatitis C virus infection and the relationship between personality traits and hypertension.

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“…16,[37][38][39]44 There was a somewhat wider spread in the point estimates for admission, with 8 comparisons (from 7 reviews) lying outside the 0.4 to 2.5 range; 20,22,26,32,33,34,37 for 3 comparisons (from 2 reviews), the 95% CIs did not reach into this region. …”

Section: Effect Sizes For Admissions and Deathmentioning

confidence: 98%

Concordance of effects of medical interventions on hospital admission and readmission rates with effects on mortality

Hemkens

Contopoulos‐Ioannidis

Ioannidis

2013

CMAJ

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Research CMAJ Background:Many clinical trials examine a composite outcome of admission to hospital and death, or infer a relationship between hospital admission and survival benefit. This assumes concordance of the outcomes "hospital admission" and "death." However, whether the effects of a treatment on hospital admissions and readmissions correlate to its effect on serious outcomes such as death is unknown. We aimed to assess the correlation and concordance of effects of medical interventions on admission rates and mortality. Methods:We searched the Cochrane Database of Systematic Reviews from its inception to January 2012 (issue 1, 2012) for systematic reviews of treatment comparisons that included meta-analyses for both admission and mortality outcomes. For each meta-analysis, we synthesized treatment effects on admissions and death, from respective randomized trials reporting those outcomes, using random-effects models. We then measured the concordance of directions of effect sizes and the correlation of summary estimates for the 2 outcomes. Results:We identified 61 meta-analyses including 398 trials reporting mortality and 182 trials reporting admission rates; 125 trials reported both outcomes. In 27.9% of comparisons, the point estimates of treatment effects for the 2 outcomes were in opposite directions; in 8.2% of trials, the 95% confidence intervals did not overlap. We found no significant correlation between effect sizes for admission and death (Pearson r = 0.07, p = 0.6). Our results were similar when we limited our analysis to trials reporting both outcomes. Interpretation:In this metaepidemiological study, admission and mortality outcomes did not correlate, and discordances occurred in about one-third of the treatment comparisons included in our analyses. Both outcomes convey useful information and should be reported separately, but extrapolating the benefits of admission to survival is unreliable and should be avoided. Abstract

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Psychological and pharmacological interventions for depression in patients with coronary artery disease

Cited by 141 publications

References 94 publications

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

Depression and anxiety in cardiovascular disease

Concordance of effects of medical interventions on hospital admission and readmission rates with effects on mortality

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