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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Identify the relationships between depression, anxiety, and heart failure (HF).• Assess methods for accurately diagnosing depression and anxiety disorders in patients with HF.• Evaluate current evidence for treatment of anxiety and depression in patients with HF. BACKGROUND In patients with heart failure (HF), depression and anxiety disorders are common and associated with adverse outcomes such as reduced adherence to treatment, poor function, increased hospitalizations, and elevated mortality. Despite the adverse impact of these disorders, anxiety and depression remain underdiagnosed and undertreated in HF patients. METHODS We performed a targeted literature review to (1) identify associations between depression, anxiety, and HF, (2) examine mechanisms mediating relationships between these conditions and medical outcomes, (3) identify methods for accurately diagnosing depression and anxiety disorders in HF, and (4) review current evidence for treatments of these conditions in this population. RESULTS Both depression and anxiety disorders are associated with the development and progression of HF, including increased rates of mortality, likely mediated through both physiologic and behavioral mechanisms. Given the overlap between cardiac and psychiatric symptoms, accurately diagnosing depression or anxiety disorders in HF patients can be challenging. Adherence to formal diagnostic criteria and utilization of a clinical interview are the best courses of action in the evaluation process. There is limited evidence for the efficacy of pharmacologic and psychotherapy in patients with HF. However, cognitive-behavioral therapy has been shown to improve mental health outcomes in patients with HF, and selective serotonin reuptake inhibitors appear safe in this cohort. CONCLUSIONS Depression and anxiety disorders in HF patients are common, underrecognized, and linked to adverse outcomes. Further research to improve detection and develop effective treatments for these disorders in HF patients is badly needed.
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Affiliation(s)
- Christopher M. Celano
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Ana C. Villegas
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | - Hanna K. Gaggin
- Harvard Medical School, Boston, MA
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA
| | - Jeff C. Huffman
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Jha MK, Qamar A, Vaduganathan M, Charney DS, Murrough JW. Screening and Management of Depression in Patients With Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73:1827-1845. [PMID: 30975301 PMCID: PMC7871437 DOI: 10.1016/j.jacc.2019.01.041] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/11/2022]
Abstract
Depression is a common problem in patients with cardiovascular disease (CVD) and is associated with increased mortality, excess disability, greater health care expenditures, and reduced quality of life. Depression is present in 1 of 5 patients with coronary artery disease, peripheral artery disease, and heart failure. Depression complicates the optimal management of CVD by worsening cardiovascular risk factors and decreasing adherence to healthy lifestyles and evidence-based medical therapies. As such, standardized screening pathways for depression in patients with CVD offer the potential for early identification and optimal management of depression to improve health outcomes. Unfortunately, the burden of depression in patients with CVD is under-recognized; as a result, screening and management strategies targeting depression have been poorly implemented in patients with CVD. In this review, the authors discuss a practical approach for the screening and management of depression in patients with CVD.
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Affiliation(s)
- Manish K Jha
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arman Qamar
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts. https://twitter.com/AqamarMD
| | - Muthiah Vaduganathan
- Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. https://twitter.com/mvaduganathan
| | - Dennis S Charney
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Office of the Dean, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James W Murrough
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York.
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Umer H, Negash A, Birkie M, Belete A. Determinates of depressive disorder among adult patients with cardiovascular disease at outpatient cardiac clinic Jimma University Teaching Hospital, South West Ethiopia: cross-sectional study. Int J Ment Health Syst 2019; 13:13. [PMID: 30867676 PMCID: PMC6399879 DOI: 10.1186/s13033-019-0269-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/22/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression and heart disease are an important public-health problem. Depression is one of the most prevalent and disabling psychiatric disorders with more than three times increased risk among patients with cardiovascular disorders. OBJECTIVE To identify the prevalence and associated factors of depressive disorder among adult patients with cardiovascular disease. METHODS Institution based cross-sectional study design was used to conduct this study on 293 study participants attending an outpatient cardiac clinic at Jimma University Teaching Hospital. All eligible patients were recruited into the study consecutively. Depression was assessed using patient health questionnaire-9. The patient health questionnaire-9 had a total score of 27, from which 0-4: no/minimal depression, 5-9: mild depression, 10-14: moderately depression, 15-19: moderately severe depression and 20-27 severe depression. The data was feed into Epi-data version 3.1 and lastly exported to SPSS version 21 for analysis. Bivariate analysis was used to analyze the statistical association of covariates of interest with depressive disorder among patients with cardiovascular disease. Then, logistic regression analysis was used as a final model to control confounders. The strength of association was measured by a 95% confidence interval. RESULTS A total of 293 adult patients diagnosed with the cardiovascular disease were included in the study with 97% (n = 284) of response rate, 47.2% (n = 134) males and 52.8% (n = 150) females, making female to a male ratio around 1.1:1. The prevalence of depression was 52.8% (n = 150/284). Out of the subjects with depression 52.67% (n = 79), 36.0% (n = 54) and 11.33% (n = 17) were mild, moderate and severe depression, respectively. Variables such as employed, unemployed, physical activity, current cigarette user and poor social support were independently associated with depression in the final model. CONCLUSIONS In this study, depression was found to be highly prevalent psychiatric comorbidity in adult cardiovascular disease patients.
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Affiliation(s)
- Halima Umer
- Research and Training Department of Amanuel Mental Specialized Hospital, Addis Abeba, Ethiopia
| | - Alemayehu Negash
- Department of Psychiatry, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mengesha Birkie
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asmare Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Kilbourne AM, Prenovost KM, Liebrecht C, Eisenberg D, Kim HM, Un H, Bauer MS. Randomized Controlled Trial of a Collaborative Care Intervention for Mood Disorders by a National Commercial Health Plan. Psychiatr Serv 2019; 70:219-224. [PMID: 30602344 PMCID: PMC6522242 DOI: 10.1176/appi.ps.201800336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Few individuals with mood disorders have access to evidence-based collaborative chronic care models (CCMs) because most patients are seen in small-group practices (<20 providers) with limited capacity to deliver CCMs. In this single-blind randomized controlled trial, we determined whether a CCM delivered nationally in a U.S. health plan improved 12-month outcomes among enrollees with mood disorders compared with usual care. METHODS Aetna insurance enrollees (N=238), mostly females (66.1%) with a mean age of 41.1 years, who were recently hospitalized for unipolar major depression or bipolar disorder provided informed consent, completed baseline assessments, and were randomly assigned to usual care or CCM. The CCM included 10 sessions of the Life Goals self-management program and brief contacts by phone by a care manager to determine symptom status. Primary outcomes were changes over 12 months in depression symptoms (nine-item Patient Health Questionnaire [PHQ-9]) and mental health-related quality of life (Short Form-12). RESULTS Adjusted mean PHQ-9 scores were lower by 2.34 points (95% confidence level [CL]=-4.18 to -0.50, p=0.01), indicating improved symptoms, and adjusted mean SF-12 mental health scores were higher by 3.21 points (CL=-.97 to 7.38, p=0.10), indicating better quality of life, among participants receiving CCM versus usual care. CONCLUSIONS Individuals receiving CCM compared with usual care had improved clinical outcomes, although substantial attrition may limit the impact of health plan-level delivery of CCMs. Further research on the use of health plan-level interventions, such as CCMs, as alternatives to practice-based models is warranted.
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Affiliation(s)
- Amy M Kilbourne
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Katherine M Prenovost
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Celeste Liebrecht
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Daniel Eisenberg
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Hyungjin Myra Kim
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Hyong Un
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Mark S Bauer
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
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Maehder K, Löwe B, Härter M, Heddaeus D, Scherer M, Weigel A. Management of comorbid mental and somatic disorders in stepped care approaches in primary care: a systematic review. Fam Pract 2019; 36:38-52. [PMID: 30535053 DOI: 10.1093/fampra/cmy122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Stepped care models comprise a graded treatment intensity and a systematic monitoring. For an effective implementation, stepped care models have to account for the high rates of mental and somatic comorbidity in primary care. OBJECTIVES The aim of the systematic review was to take stock of whether present stepped care models take comorbidities into consideration. A further aim was to give an overview on treatment components and involved health care professionals. METHODS A systematic literature search was performed using the databases PubMed, PsycINFO, Cochrane Library and Web of Science. Selection criteria were a randomized controlled trial of a primary-care-based stepped care intervention, adult samples, publication between 2000 and 2017 and English or German language. RESULTS Of 1009 search results, 39 studies were eligible. One-third of the trials were conceived for depressive disorders only, one-third for depression and further somatic and/or mental comorbidity and one-third for conditions other than depression. In 39% of the studies comorbidities were explicitly integrated in treatment, mainly via transdiagnostic self-management support, interprofessional collaboration and digital approaches for treatment, monitoring and communication. Most care teams were composed of a primary care physician, a care manager and a psychiatrist and/or psychologist. Due to the heterogeneity of the addressed disorders, no meta-analysis was performed. CONCLUSIONS Several stepped care models in primary care already account for comorbidities, with depression being the predominant target disorder. To determine their efficacy, the identified strategies to account for comorbidities should be investigated within stepped care models for a broader range of disorders.
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Affiliation(s)
- Kerstin Maehder
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Daniela Heddaeus
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Scherer
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
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Kabboul NN, Tomlinson G, Francis TA, Grace SL, Chaves G, Rac V, Daou-Kabboul T, Bielecki JM, Alter DA, Krahn M. Comparative Effectiveness of the Core Components of Cardiac Rehabilitation on Mortality and Morbidity: A Systematic Review and Network Meta-Analysis. J Clin Med 2018; 7:E514. [PMID: 30518047 PMCID: PMC6306907 DOI: 10.3390/jcm7120514] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/26/2018] [Accepted: 11/30/2018] [Indexed: 01/12/2023] Open
Abstract
A systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating the core components of cardiac rehabilitation (CR), nutritional counseling (NC), risk factor modification (RFM), psychosocial management (PM), patient education (PE), and exercise training (ET)) was undertaken. Published RCTs were identified from database inception dates to April 2017, and risk of bias assessed using Cochrane's tool. Endpoints included mortality (all-cause and cardiovascular (CV)) and morbidity (fatal and non-fatal myocardial infarction (MI), coronary artery bypass surgery (CABG), percutaneous coronary intervention (PCI), and hospitalization (all-cause and CV)). Meta-regression models decomposed treatment effects into the main effects of core components, and two-way or all-way interactions between them. Ultimately, 148 RCTs (50,965 participants) were included. Main effects models were best fitting for mortality (e.g., for all-cause, specifically PM (hazard ratio HR = 0.68, 95% credible interval CrI = 0.54⁻0.85) and ET (HR = 0.75, 95% CrI = 0.60⁻0.92) components effective), MI (e.g., for all-cause, specifically PM (hazard ratio HR = 0.76, 95% credible interval CrI = 0.57⁻0.99), ET (HR = 0.75, 95% CrI = 0.56⁻0.99) and PE (HR = 0.68, 95% CrI = 0.47⁻0.99) components effective) and hospitalization (e.g., all-cause, PM (HR = 0.76, 95% CrI = 0.58⁻0.96) effective). For revascularization (including CABG and PCI individually), the full interaction model was best-fitting. Given that each component, individual or in combination, was associated with mortality and/or morbidity, recommendations for comprehensive CR are warranted.
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Affiliation(s)
- Nader N Kabboul
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
| | - George Tomlinson
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Department of Medicine, University Health Network, 27 King's College Circle, Toronto, ON M5S 1A1, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3M6, Canada.
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
| | - Troy A Francis
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
| | - Sherry L Grace
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
- Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Ave, Toronto, ON M5G 2A2, Canada.
- School of Kinesiology and Health Science, York University, 4700 Keele St, Toronto, ON M3J 1P3, Canada.
| | - Gabriela Chaves
- Department of Physical Therapy, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627-Pampulha, Belo Horizonte, MG 31270-901, Brazil.
| | - Valeria Rac
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
| | - Tamara Daou-Kabboul
- Human Nutrition, Bridgeport University, 126 Park Ave, Bridgeport, CT 06604, USA.
| | - Joanna M Bielecki
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
| | - David A Alter
- Department of Medicine, University Health Network, 27 King's College Circle, Toronto, ON M5S 1A1, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3M6, Canada.
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
- Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Ave, Toronto, ON M5G 2A2, Canada.
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
- Department of Medicine, University Health Network, 27 King's College Circle, Toronto, ON M5S 1A1, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3M6, Canada.
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
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Emery-Tiburcio EE, Rothschild SK, Avery EF, Wang Y, Mack L, Golden RL, Holmgreen L, Hobfoll S, Richardson D, Powell LH. BRIGHTEN Heart intervention for depression in minority older adults: Randomized controlled trial. Health Psychol 2018; 38:1-11. [PMID: 30382712 DOI: 10.1037/hea0000684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Assess the effectiveness of an interdisciplinary geriatric team intervention in decreasing symptoms of depression among urban minority older adults in primary care. Secondary outcomes included cardiometabolic syndrome and trauma. METHOD 250 African American and Hispanic older adults with PHQ-9 scores ≥ 8 and BMI ≥ 25 were recruited from 6 underserved urban primary care clinics. Intervention arm participants received the BRIGHTEN Heart team intervention plus membership in Generations, an older adult educational activity program; comparison participants received only Generations. RESULTS Both arms demonstrated clinically significant improvements in PHQ-9 scores at 6 months (-5 points, intervention and comparison) and 12 months (-7 points intervention, -6.5 points comparison); there was no significant difference in change scores between groups on depression or cardiometabolic syndrome at 6 months; there was a small difference in depression trajectory at 12 months (p < .001). More participants in the treatment group (70.7%) had greater than 50% reduction in PHQ-9 scores than the comparison group (56.3%; p = .036). For those with higher PTSD symptoms (PCL-C6), improvement in depression was significantly better in the intervention arm than the comparison arm, regardless of baseline PHQ-9 (p = .001). In mixed models, those with higher PTSD symptoms (β = -0.012, p = < 0.001) in the intervention arm showed greater depression improvement than those with lower PTSD symptoms (β = -0.004, p = .001). CONCLUSIONS The BRIGHTEN Heart intervention may be effective in reducing depression for urban minority older adults. Further research on team care interventions and screening for PTSD symptoms in primary care is warranted. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Yamin Wang
- Preventive Medicine, Rush University Medical Center
| | - Laurin Mack
- Behavioral Sciences, Rush University Medical Center
| | - Robyn L Golden
- Social Work and Community Health, Rush University Medical Center
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van Egmond M, van der Schaaf M, Vredeveld T, Vollenbroek-Hutten M, van Berge Henegouwen M, Klinkenbijl J, Engelbert R. Effectiveness of physiotherapy with telerehabilitation in surgical patients: a systematic review and meta-analysis. Physiotherapy 2018; 104:277-298. [DOI: 10.1016/j.physio.2018.04.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 04/11/2018] [Indexed: 11/29/2022]
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Dale JG, Midthus E, Dale B. Using information and communication technology in the recovery after a coronary artery bypass graft surgery: patients' attitudes. J Multidiscip Healthc 2018; 11:417-423. [PMID: 30214223 PMCID: PMC6121744 DOI: 10.2147/jmdh.s175195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients who have undergone a coronary artery bypass graft (CABG) surgery are exposed to physical and mental problems after discharge from the specialist hospital and are often in need of post-discharge support and follow-up. AIM This study aimed to explore the attitudes of CABG patients toward using information and communication technology (ICT) during the first year of recovery after discharge from hospital. METHODS A cross-sectional design utilizing an electronic survey was employed. The sample consisted of 197 patients who had undergone a CABG surgery during 2015. The questionnaire included questions about follow-up needs, contacts with health professionals, use of the Internet, and attitudes toward using ICT in the recovery phase. RESULTS Mean age of the participants was 67.3 years; 18.3% were women. A total of 48.2% of the patient group was satisfied with the pre-discharge information. Only 27% had contacted the hospital after discharge. Whereas 58.4% of the participants had used the Internet to acquire information, only 30.4% found this information to be useful. Many patients (40%) reported that they could benefit from online health information and Skype meetings with professionals. More than 30% reported that nutritional guidance on the Internet could be motivating for choosing healthy diets, and 42.6% reported that Internet-based illustrative videotapes could be motivating for undertaking physical training. CONCLUSION ICT can be useful and resource-saving for patients who have undergone a CABG surgery, as well as for the health care services. The technology must be appropriately tailored, with regard to content and design, to be helpful for patients.
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Affiliation(s)
- Jan Gunnar Dale
- University of Agder, Institute of Health and Nursing Science, Grimstad, Norway,
| | | | - Bjørg Dale
- Centre for Care Research, Southern Norway, University of Agder, Grimstad, Norway
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Telephone-based mindfulness training to reduce stress in women with myocardial infarction: Rationale and design of a multicenter randomized controlled trial. Am Heart J 2018; 202:61-67. [PMID: 29864732 PMCID: PMC7432959 DOI: 10.1016/j.ahj.2018.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Elevated stress is associated with adverse cardiovascular disease outcomes and accounts in part for the poorer recovery experienced by women compared with men after myocardial infarction (MI). Psychosocial interventions improve outcomes overall but are less effective for women than for men with MI, suggesting the need for different approaches. Mindfulness-based cognitive therapy (MBCT) is an evidence-based intervention that targets key psychosocial vulnerabilities in women including rumination (i.e., repetitive negative thinking) and low social support. This article describes the rationale and design of a multicenter randomized controlled trial to test the effects of telephone-delivered MBCT (MBCT-T) in women with MI. METHODS We plan to randomize 144 women reporting elevated perceived stress at least two months after MI to MBCT-T or enhanced usual care (EUC), which each involve eight weekly telephone sessions. Perceived stress and a set of patient-centered health outcomes and potential mediators will be assessed before and after the 8-week telephone programs and at 6-month follow-up. We will test the hypothesis that MBCT-T will be associated with greater 6-month improvements in perceived stress (primary outcome), disease-specific health status, quality of life, depression and anxiety symptoms, and actigraphy-based sleep quality (secondary outcomes) compared with EUC. Changes in mindfulness, rumination and perceived social support will be evaluated as potential mediators in exploratory analyses. CONCLUSIONS If found to be effective, this innovative, scalable intervention may be a promising secondary prevention strategy for women with MI experiencing elevated perceived stress.
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Li S, Blumenthal JA, Shi C, Millican D, Li X, Du X, Patel A, Gao P, Delong E, Maulik PK, Gao R, Yu X, Wu Y. I-CARE randomized clinical trial integrating depression and acute coronary syndrome care in low-resource hospitals in China: Design and rationale. Am Heart J 2018; 202:109-115. [PMID: 29933147 DOI: 10.1016/j.ahj.2018.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/16/2018] [Indexed: 12/18/2022]
Abstract
Depression and acute coronary syndromes (ACS) are both common public health challenges. Patients with ACS often develop depression, which in turn adversely affects prognosis. Low-cost, sustainable, and effective service models that integrate depression care into the management of ACS patients to reduce depression and improve ACS outcomes are critically needed. Integrating Depression Care in ACS patients in Low Resource Hospitals in China (I-CARE) is a multicenter, randomized controlled trial to evaluate the efficacy of an 11-month integrated care (IC) intervention compared to usual care (UC) in management of ACS patients. Four thousand inpatients will be recruited and then randomized in a 1:1 ratio to an IC intervention consisting of nurse-led risk factor management, group-based counseling supplemented by individual problem-solving therapy, and antidepressant medications as needed, or to UC. The primary outcomes are depression symptoms measured by the Patient Health Questionnaire-9 at 6 and 12 months. Secondary endpoints include anxiety measured by the Generalized Anxiety Disorder-7; quality of life measured by the EQ-5D at 6 and 12 months; and major adverse events including the combined end point of all-cause death, suicide attempts, nonfatal myocardial infarction, nonfatal stroke, and all-cause rehospitalization at yearly intervals for a median follow-up of 2 years. Analyses of the cost-effectiveness and cost-utility of IC also will be performed. I-CARE trial will be the largest study to test the effectiveness of an integrated care model on depression and cardiovascular outcomes among ACS patients in resource-limited clinical settings.
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63
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Campo JV, Geist R, Kolko DJ. Integration of Pediatric Behavioral Health Services in Primary Care: Improving Access and Outcomes with Collaborative Care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:432-438. [PMID: 29673268 PMCID: PMC6099777 DOI: 10.1177/0706743717751668] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine collaborative care interventions to integrate pediatric mental health services into primary care as a means of addressing barriers to mental health service delivery, improving access to care, and improving health outcomes. METHOD Selective review of published literature addressing structural and attitudinal barriers to behavioural health service delivery and the integration of behavioural health services for pediatric mental problems and disorders into primary care settings, with a special focus on Canadian and U.S. RESULTS Integration of pediatric behavioural health services in primary care has potential to address structural and attitudinal barriers to care delivery, including shortages and the geographical misdistribution of behavioural health specialists. Integration challenges stigma by communicating that health cannot be compartmentalized into physical and mental components. Stepped collaborative care interventions have been demonstrated to be feasible and effective in improving access to behavioural health services, outcomes, and patient and family satisfaction relative to existing care models. CONCLUSION Collaborative integration of behavioural health services into primary care is a promising means of improving access to care and outcomes for children and adolescents struggling with mental problems and disorders. Dissemination to real-world practice settings will likely require changes to existing models of reimbursement and the culture of health service delivery.
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Affiliation(s)
- John V Campo
- 1 Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Rose Geist
- 2 Medical Psychiatry Alliance, Mental Health Program, Trillium Health Partners, University of Toronto, Toronto, Ontario, Canada
| | - David J Kolko
- 3 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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64
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Huffman JC, Mastromauro CA, Boehm JK, Seabrook R, Fricchione GL, Denninger JW, Lyubomirsky S. Development of a Positive Psychology Intervention for Patients with Acute Cardiovascular Disease. Heart Int 2018. [DOI: 10.4081/hi.2011.e13a] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jeff C. Huffman
- Harvard Medical School, Boston, MA
- Department of Psychiatry Massachusetts General Hospital, Boston, MA
| | | | | | - Rita Seabrook
- Department of Psychiatry Massachusetts General Hospital, Boston, MA
| | - Gregory L. Fricchione
- Harvard Medical School, Boston, MA
- Department of Psychiatry Massachusetts General Hospital, Boston, MA
- Benson Henry Institute for Mind Body Medicine, Boston, MA
| | - John W. Denninger
- Harvard Medical School, Boston, MA
- Department of Psychiatry Massachusetts General Hospital, Boston, MA
- Benson Henry Institute for Mind Body Medicine, Boston, MA
| | - Sonja Lyubomirsky
- Department of Psychology, University of California at Riverside, CA, USA
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65
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Bekelman DB, Allen LA, McBryde CF, Hattler B, Fairclough DL, Havranek EP, Turvey C, Meek PM. Effect of a Collaborative Care Intervention vs Usual Care on Health Status of Patients With Chronic Heart Failure: The CASA Randomized Clinical Trial. JAMA Intern Med 2018; 178:511-519. [PMID: 29482218 PMCID: PMC5876807 DOI: 10.1001/jamainternmed.2017.8667] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE Many patients with chronic heart failure experience reduced health status despite receiving conventional therapy. OBJECTIVE To determine whether a symptom and psychosocial collaborative care intervention improves heart failure-specific health status, depression, and symptom burden in patients with heart failure. DESIGN, SETTING, AND PARTICIPANTS A single-blind, 2-arm, multisite randomized clinical trial was conducted at Veterans Affairs, academic, and safety-net health systems in Colorado among outpatients with symptomatic heart failure and reduced health status recruited between August 2012 and April 2015. Data from all participants were included regardless of level of participation, using an intent-to-treat approach. INTERVENTIONS Patients were randomized 1:1 to receive the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) intervention or usual care. The CASA intervention included collaborative symptom care provided by a nurse and psychosocial care provided by a social worker, both of whom worked with the patients' primary care clinicians and were supervised by a study primary care clinician, cardiologist, and palliative care physician. MAIN OUTCOMES AND MEASURES The primary outcome was patient-reported heart failure-specific health status, measured by difference in change scores on the Kansas City Cardiomyopathy Questionnaire (range, 0-100) at 6 months. Secondary outcomes included depression (measured by the 9-item Patient Health Questionnaire), anxiety (measured by the 7-item Generalized Anxiety Disorder Questionnaire), overall symptom distress (measured by the General Symptom Distress Scale), specific symptoms (pain, fatigue, and shortness of breath), number of hospitalizations, and mortality. RESULTS Of 314 patients randomized (157 to intervention arm and 157 to control arm), there were 67 women and 247 men, mean (SD) age was 65.5 (11.4) years, and 178 (56.7%) had reduced ejection fraction. At 6 months, the mean Kansas City Cardiomyopathy Questionnaire score improved 5.5 points in the intervention arm and 2.9 points in the control arm (difference, 2.6; 95% CI, -1.3 to 6.6; P = .19). Among secondary outcomes, depressive symptoms and fatigue improved at 6 months with CASA (effect size of -0.29 [95% CI, -0.53 to -0.04] for depressive symptoms and -0.30 [95% CI, -0.55 to -0.06] for fatigue; P = .02 for both). There were no significant changes in overall symptom distress, pain, shortness of breath, or number of hospitalizations. Mortality at 12 months was similar in both arms (10 patients died receiving CASA, and 13 patients died receiving usual care; P = .52). CONCLUSIONS AND RELEVANCE This multisite randomized clinical trial of the CASA intervention did not demonstrate improved heart failure-specific health status. Secondary outcomes of depression and fatigue, both difficult symptoms to treat in heart failure, improved. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01739686.
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Affiliation(s)
- David B Bekelman
- Department of Medicine, Department of Veterans Affairs, Eastern Colorado Health Care System, Denver.,Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Connor F McBryde
- Department of Medicine, Department of Veterans Affairs, Eastern Colorado Health Care System, Denver.,Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Brack Hattler
- Department of Medicine, Department of Veterans Affairs, Eastern Colorado Health Care System, Denver.,Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Diane L Fairclough
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado
| | - Edward P Havranek
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora.,Department of Medicine, Denver Health, Denver, Colorado
| | | | - Paula M Meek
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora
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66
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Wang L, Chang Y, Kennedy SA, Hong PJ, Chow N, Couban RJ, McCabe RE, Bieling PJ, Busse JW. Perioperative psychotherapy for persistent post-surgical pain and physical impairment: a meta-analysis of randomised trials. Br J Anaesth 2018; 120:1304-1314. [PMID: 29793597 DOI: 10.1016/j.bja.2017.10.026] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 09/27/2017] [Accepted: 10/23/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Persistent post-surgical pain affects 10-80% of individuals after common operations, and is more common among patients with psychological factors such as depression, anxiety, or catastrophising. METHODS We conducted a systematic review and meta-analysis of randomised, controlled trials to evaluate the efficacy of perioperative psychotherapy for persistent post-surgical pain and physical impairment. Paired independent reviewers identified studies, extracted data, and assessed risk of bias. The Grading of Recommendations, Assessment, Development and Evaluation system was used to assess the quality of evidence. RESULTS Our search of five electronic databases, up to September 1, 2016, found 15 trials (2220 patients) that were eligible for review. For both persistent post-surgical pain and physical impairment, perioperative education was ineffective, while active psychotherapy suggested a benefit (test of interaction P=0.01 for both outcomes). Moderate quality evidence showed that active perioperative psychotherapy (cognitive-behaviour therapy, relaxation therapy, or both) significantly reduced persistent post-surgical pain [weighted mean difference (WMD) -1.06 cm on a 10 cm visual analogue scale for pain, 95% confidence interval (CI) -1.56 to -0.55 cm; risk difference (RD) for achieving no more than mild pain (≤3 cm) 14%, 95% CI 8-21%] and physical impairment [WMD -9.87% on the 0-100% Oswestry Disability Index, 95% CI -13.42 to -6.32%, RD for achieving no more than mild disability (≤20%) 21%, 95% CI 13-29%]. CONCLUSIONS Perioperative cognitive behavioural therapy and relaxation therapy are effective for reducing persistent pain and physical impairment after surgery. Future studies should explore targeted psychotherapy for surgical patients at higher risk for poor outcome. CLINICAL TRIAL REGISTRATION PROSPERO CRD42016047335.
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Affiliation(s)
- L Wang
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Y Chang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - S A Kennedy
- Department of Diagnostic Radiology, University of Toronto, Toronto, Ontario, Canada
| | - P J Hong
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - N Chow
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - R J Couban
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - R E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mental Health and Addictions Program, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - P J Bieling
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mental Health and Addictions Program, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - J W Busse
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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67
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Schulberg HC. My Odyssey Through the Changing World of Mental Health. Am J Geriatr Psychiatry 2018; 26:257-263. [PMID: 29198429 DOI: 10.1016/j.jagp.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Herbert C Schulberg
- Professor Emeritus of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; Clinical Professor Emeritus of Psychology in Psychiatry, Weill Cornell Medicine, New York, NY.
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68
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van Eck van der Sluijs JF, Castelijns H, Eijsbroek V, Rijnders CAT, van Marwijk HWJ, van der Feltz-Cornelis CM. Illness burden and physical outcomes associated with collaborative care in patients with comorbid depressive disorder in chronic medical conditions: A systematic review and meta-analysis. Gen Hosp Psychiatry 2018; 50:1-14. [PMID: 28957682 DOI: 10.1016/j.genhosppsych.2017.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Collaborative care (CC) improves depressive symptoms in people with comorbid depressive disorder in chronic medical conditions, but its effect on physical symptoms has not yet systematically been reviewed. This study aims to do so. METHODS Systematic review and meta-analysis was conducted using PubMed, the Cochrane Library, and the European and US Clinical Trial Registers. Eligible studies included randomized controlled trials (RCTs) of CC compared to care as usual (CAU), in primary care and general hospital setting, reporting on physical and depressive symptoms as outcomes. Overall treatment effects were estimated for illness burden, physical outcomes and depression, respectively. RESULTS Twenty RCTs were included, with N=4774 patients. The overall effect size of CC versus CAU for illness burden was OR 1.64 (95%CI 1.47;1.83), d=0.27 (95%CI 0.21;0.33). Best physical outcomes in CC were found for hypertension with comorbiddepression. Overall, depression outcomes were better for CC than for CAU. Moderator analyses did not yield statistically significant differences. CONCLUSIONS CC is more effective than CAU in terms of illness burden, physical outcomes and depression, in patients with comorbid depression in chronic medical conditions. More research covering multiple medical conditions is needed. PROTOCOL REGISTRATION NUMBER The protocol for this systematic review and meta-analysis has been registered at the International Prospective Register of Systematic Reviews (PROSPERO) on February 19th 2016: http://www.crd.york.ac.uk/PROSPERO/DisplayPDF.php?ID=CRD42016035553.
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Affiliation(s)
- Jonna F van Eck van der Sluijs
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands; Tranzo Department, Tilburg University, Tilburg, The Netherlands; Department of Residency Training, GGz Breburg, Tilburg, The Netherlands
| | - Hilde Castelijns
- Centre for Mental Health Care, PsyQ Tilburg-Parnassia Groep, Tilburg, The Netherlands
| | - Vera Eijsbroek
- Department of Residency Training, GGz Breburg, Tilburg, The Netherlands
| | | | - Harm W J van Marwijk
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom; Department of General Practice & Elderly Care Medicine and the EMGO+, Institute for Health and Care Research of VU University Medical Centre (VUmc), Amsterdam, The Netherlands
| | - Christina M van der Feltz-Cornelis
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands; Tranzo Department, Tilburg University, Tilburg, The Netherlands.
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69
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Rollman BL, Herbeck Belnap B, Abebe KZ, Spring MB, Rotondi AJ, Rothenberger SD, Karp JF. Effectiveness of Online Collaborative Care for Treating Mood and Anxiety Disorders in Primary Care: A Randomized Clinical Trial. JAMA Psychiatry 2018; 75:56-64. [PMID: 29117275 PMCID: PMC5833533 DOI: 10.1001/jamapsychiatry.2017.3379] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Collaborative care for depression and anxiety is superior to usual care from primary care physicians for these conditions; however, challenges limit its provision in routine practice and at scale. Advances in technology may overcome these barriers but have yet to be tested. OBJECTIVE To examine the effectiveness of combining an internet support group (ISG) with an online computerized cognitive behavioral therapy (CCBT) provided via a collaborative care program for treating depression and anxiety vs CCBT alone and whether providing CCBT in this manner is more effective than usual care. DESIGN, SETTING, AND PARTICIPANTS In this 3-arm randomized clinical trial with blinded outcome assessments, primary care physicians from 26 primary care practices in Pittsburgh, Pennsylvania, referred 2884 patients aged 18 to 75 years in response to an electronic medical record prompt from August 2012 to September 2014. Overall, 704 patients (24.4%) met all eligibility criteria and were randomized to CCBT alone (n = 301), CCBT+ISG (n = 302), or usual care (n = 101). Intent-to-treat analyses were conducted November 2015 to January 2017. INTERVENTIONS Six months of guided access to an 8-session CCBT program provided by care managers who informed primary care physicians of their patients' progress and promoted patient engagement with our online programs. MAIN OUTCOMES AND MEASURES Mental health-related quality of life (12-Item Short-Form Health Survey Mental Health Composite Scale) and depression and anxiety symptoms (Patient-Reported Outcomes Measurement Information System) at 6-month follow-up, with treatment durability assessed 6 months later. RESULTS Of the 704 randomized patients, 562 patients (79.8%) were female, and the mean (SD) age was 42.7 (14.3) years. A total of 604 patients (85.8%) completed our primary 6-month outcome assessment. At 6-month assessment, 254 of 301 patients (84.4%) receiving CCBT alone started the program (mean [SD] sessions completed, 5.4 [2.8]), and 228 of 302 patients (75.5%) in the CCBT+ISG cohort logged into the ISG at least once, of whom 141 (61.8%) provided 1 or more comments or posts (mean, 10.5; median [range], 3 [1-306]). Patients receiving CCBT+ISG reported similar 6-month improvements in mental health-related quality of life, mood, and anxiety symptoms compared with patients receiving CCBT alone. However, compared with patients receiving usual care, patients in the CCBT alone cohort reported significant 6-month effect size improvements in mood (effect size, 0.31; 95% CI, 0.09-0.53) and anxiety (effect size, 0.26; 95% CI, 0.05-0.48) that persisted 6 months later, and completing more CCBT sessions produced greater effect size improvements in mental health-related quality of life and symptoms. CONCLUSIONS AND RELEVANCE While providing moderated access to an ISG provided no additional benefit over guided CCBT at improving mental health-related quality of life, mood, and anxiety symptoms, guided CCBT alone is more effective than usual care for these conditions. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01482806.
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Affiliation(s)
- Bruce L. Rollman
- Division of General Internal Medicine, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Center for Behavioral Health and Smart Technology,
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bea Herbeck Belnap
- Division of General Internal Medicine, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Center for Behavioral Health and Smart Technology,
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kaleab Z. Abebe
- Division of General Internal Medicine, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Center for Clinical Trials and Data Coordination,
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michael B. Spring
- School of Information Science and Technology,
University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Armando J. Rotondi
- Center for Behavioral Health and Smart Technology,
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,School of Information Science and Technology,
University of Pittsburgh, Pittsburgh, Pennsylvania,Mental Illness Research, Education, and Clinical
Center, VA Pittsburgh Health Care System, Department of Veterans Affairs, Pittsburgh,
Pennsylvania
| | - Scott D. Rothenberger
- Division of General Internal Medicine, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Center for Clinical Trials and Data Coordination,
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jordan F. Karp
- Department of Psychiatry, University of Pittsburgh
School of Medicine, Pittsburgh, Pennsylvania
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Dham P, Colman S, Saperson K, McAiney C, Lourenco L, Kates N, Rajji TK. Collaborative Care for Psychiatric Disorders in Older Adults: A Systematic Review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:761-771. [PMID: 28718325 PMCID: PMC5697628 DOI: 10.1177/0706743717720869] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the mode of implementation, clinical outcomes, cost-effectiveness, and the factors influencing uptake and sustainability of collaborative care for psychiatric disorders in older adults. DESIGN Systematic review. SETTING Primary care, home health care, seniors' residence, medical inpatient and outpatient. PARTICIPANTS Studies with a mean sample age of 60 years and older. INTERVENTION Collaborative care for psychiatric disorders. METHODS PubMed, MEDLINE, Embase, and Cochrane databases were searched up until October 2016. Individual randomized controlled trials and cohort, case-control, and health service evaluation studies were selected, and relevant data were extracted for qualitative synthesis. RESULTS Of the 552 records identified, 53 records (from 29 studies) were included. Very few studies evaluated psychiatric disorders other than depression. The mode of implementation differed based on the setting, with beneficial use of telemedicine. Clinical outcomes for depression were significantly better compared with usual care across settings. In depression, there is some evidence for cost-effectiveness. There is limited evidence for improved dementia care and outcomes using collaborative care. There is a lack of evidence for benefit in disorders other than depression or in settings such as home health care and general acute inpatients. Attitudes and skill of primary care staff, availability of resources, and organizational support are some of the factors influencing uptake and implementation. CONCLUSIONS Collaborative care for depressive disorders is feasible and beneficial among older adults in diverse settings. There is a paucity of studies on collaborative care in conditions other than depression or in settings other than primary care, indicating the need for further evaluation.
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Affiliation(s)
- Pallavi Dham
- 1 Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Colman
- 1 Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Karen Saperson
- 3 Department of Psychiatry & Behavioral Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Carrie McAiney
- 3 Department of Psychiatry & Behavioral Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lillian Lourenco
- 1 Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nick Kates
- 3 Department of Psychiatry & Behavioral Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tarek K Rajji
- 1 Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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71
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Huffman JC, Adams CN, Celano CM. Collaborative Care and Related Interventions in Patients With Heart Disease: An Update and New Directions. PSYCHOSOMATICS 2017; 59:1-18. [PMID: 29078987 DOI: 10.1016/j.psym.2017.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Psychiatric disorders, such as depression, are very common in cardiac patients and are independently linked to adverse cardiac outcomes, including mortality. Collaborative care and other integrated care models have been used successfully to manage psychiatric conditions in patients with heart disease, with beneficial effects on function and other outcomes. Novel programs using remote delivery of mental health interventions and promotion of psychological well-being may play an increasingly large role in supporting cardiovascular health. METHODS We review prior studies of standard and expanded integrated care programs among patients with cardiac disease, examine contemporary intervention delivery methods (e.g., Internet or mobile phone) that could be adapted for these programs, and outline mental health-related interventions to promote healthy behaviors and overall recovery across all cardiac patients. RESULTS Standard integrated care models for mental health disorders are effective at improving mood, anxiety, and function in patients with heart disease. Novel, "blended" collaborative care models may have even greater promise in improving cardiac outcomes, and interfacing with cardiac patients via mobile applications, text messages, and video visits may provide additional benefit. A variety of newer interventions using stress management, mindfulness, or positive psychology have shown promising effects on mental health, health behaviors, and overall cardiac outcomes. CONCLUSIONS Further study of novel applications of collaborative care and related interventions is warranted given the potential of these programs to increase the reach and effect of mental health interventions in patients with heart disease.
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Affiliation(s)
- Jeff C Huffman
- Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
| | - Caitlin N Adams
- Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Cully JA, Stanley MA, Petersen NJ, Hundt NE, Kauth MR, Naik AD, Sorocco K, Sansgiry S, Zeno D, Kunik ME. Delivery of Brief Cognitive Behavioral Therapy for Medically Ill Patients in Primary Care: A Pragmatic Randomized Clinical Trial. J Gen Intern Med 2017; 32. [PMID: 28634906 PMCID: PMC5570751 DOI: 10.1007/s11606-017-4101-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few studies have examined the practical effectiveness and implementation potential of brief psychotherapies that integrate mental and physical health. OBJECTIVE To determine whether an integrated brief cognitive behavioral therapy (bCBT), delivered by mental health providers in primary care, would improve depression, anxiety and quality of life for medically ill veterans. DESIGN Pragmatic patient-randomized trial comparing bCBT to enhanced usual care (EUC). PARTICIPANTS A total of 302 participants with heart failure and/or chronic obstructive pulmonary disease (COPD) with elevated symptoms of depression and/or anxiety were enrolled from two Veterans Health Administration primary care clinics. INTERVENTION bCBT was delivered to 180 participants by staff mental health providers (n = 19). bCBT addressed physical and emotional health using a modular, skill-based approach. bCBT was delivered in person or by telephone over 4 months. Participants randomized to EUC (n = 122) received a mental health assessment documented in their medical record. MAIN MEASURES Primary outcomes included depression (Patient Health Questionnaire) and anxiety (Beck Anxiety Inventory). Secondary outcomes included health-related quality of life. Assessments occurred at baseline, posttreatment (4 months), and 8- and 12-month follow-up. KEY RESULTS Participants received, on average, 3.9 bCBT sessions with 63.3% completing treatment (4+ sessions). bCBT improved symptoms of depression (p = 0.004; effect size, d = 0.33) and anxiety (p < 0.001; d = 0.37) relative to EUC at posttreatment, with effects maintained at 8 and 12 months. Health-related quality of life improved posttreatment for bCBT participants with COPD but not for heart failure. Health-related quality of life outcomes were not maintained at 12 months. CONCLUSIONS Integrated bCBT is acceptable to participants and providers, appears feasible for delivery in primary care settings and is effective for medically ill veterans with depression and anxiety. Improvements for both depression and anxiety were modest but persistent, and the impact on physical health outcomes was limited to shorter-term effects and COPD participants. Clinical trials.Gov identifier: NCT01149772.
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Affiliation(s)
- Jeffrey A Cully
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA. .,Baylor College of Medicine, Houston, TX, USA. .,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA.
| | - Melinda A Stanley
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
| | - Nancy J Petersen
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Natalie E Hundt
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
| | - Michael R Kauth
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
| | - Aanand D Naik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
| | - Kristen Sorocco
- Oklahoma City VA Healthcare System, Oklahoma City, OK, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shubhada Sansgiry
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
| | - Darrell Zeno
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
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73
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Huffman JC, Legler SR, Boehm JK. Positive psychological well-being and health in patients with heart disease: a brief review. Future Cardiol 2017; 13:443-450. [PMID: 28828901 DOI: 10.2217/fca-2017-0016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Poor psychological health (e.g., depression and anxiety) is prospectively associated with adverse cardiac outcomes. In contrast, there is increasing evidence that positive psychological constructs like happiness, optimism and gratitude are independently and prospectively linked to better health behaviors and superior cardiac prognosis in people with and without heart disease. However, a critical question is whether such positive states and traits are modifiable. Recent studies of systematic positive psychology interventions designed to promote well-being have shown promise in patients with heart disease, and more data are needed to learn whether these interventions are effective and whether they can be broadly applied to impact public health.
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Affiliation(s)
- Jeff C Huffman
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sean R Legler
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Julia K Boehm
- Department of Psychology, Chapman University, Orange, CA 92866, USA
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74
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Colella TJ, King-Shier K. The effect of a peer support intervention on early recovery outcomes in men recovering from coronary bypass surgery: A randomized controlled trial. Eur J Cardiovasc Nurs 2017; 17:408-417. [PMID: 28805455 DOI: 10.1177/1474515117725521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIM Examine the effect of a professionally-guided telephone peer support intervention on recovery outcomes including depression, perceived social support, and health services utilization after coronary artery bypass graft surgery (CABG). METHODS A randomized controlled trial was conducted with post-coronary artery bypass graft surgery men ( N=185) who were randomized before hospital discharge. The intervention arm received telephone-based peer support through weekly telephone calls from a peer volunteer over six weeks, initiated within 3-4 days of discharge. RESULTS Although a significant difference was detected in pre-intervention depression scores at discharge, there were no differences between groups in changes in depression scores at six weeks ( p=0.08), 12 weeks (0.49) or over time ( p=0.51); and no significant differences in perceived social support scores over time ( p=0.94). At 12 weeks, the intervention group had significantly lower incidence of health services utilization (family physician ( p=0.02) and emergency room ( p=0.04)). CONCLUSIONS Healthcare providers need to continue to investigate novel interventions to enhance social support and reduce depression in cardiac patients.
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Affiliation(s)
- Tracey Jf Colella
- 1 University Health Network/Toronto Rehab Cardiovascular Prevention & Rehabilitation Program, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn King-Shier
- 2 Faculty of Nursing, Department of Community Health Sciences, University of Calgary, Alberta, Canada
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75
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Chen Y, Ding S, Tao X, Feng X, Lu S, Shen Y, Wu Y, An X. The quality of life of patients developed delirium after coronary artery bypass grafting is determined by cognitive function after discharge: A cross-sectional study. Int J Nurs Pract 2017; 23. [PMID: 28752905 DOI: 10.1111/ijn.12563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 03/21/2017] [Accepted: 04/30/2017] [Indexed: 12/14/2022]
Abstract
AIMS Postoperative delirium (POD) and declined cognitive function were common in patients (especially elderly patients) who underwent coronary artery bypass grafting (CABG), which may affect quality of life (QoL). The aim of this study was to determine the relationships among age, POD, declined cognitive function, and QoL in patients who underwent CABG. METHODS Consecutive patients who underwent first time elective CABG and assessed for POD using Confusion Assessment Method for intensive care unit for 5 postoperative days from November 2013 to March 2015 were recruited. A cross-sectional study was conducted during April 2015 to assess their cognitive function and QoL, using the Telephone Interview for Cognitive Status Scale and Medical Outcomes Study 36-Item Short Form Health Survey. The relationships among age, POD, declined cognitive function, and QoL were tested using path analysis. RESULTS Declined cognitive function was associated with poorer QoL. POD was associated with declined cognitive function but was not associated with poorer QoL. Ageing was not associated with QoL but was associated with POD and declined cognitive function. CONCLUSION The QoL of patients developed delirium after CABG is determined by cognitive function after discharge. Necessary strategies should be implemented to prevent POD and declined cognitive function, especially in elderly patients.
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Affiliation(s)
- Yuling Chen
- School of Nursing, Capital Medical University, Beijing, China
| | - Shu Ding
- School of Nursing, Capital Medical University, Beijing, China
| | - Xiangjun Tao
- School of Nursing, Capital Medical University, Beijing, China
| | - Xinwei Feng
- School of Nursing, Capital Medical University, Beijing, China
| | - Sai Lu
- School of Nursing and Midwifery College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Yuzhi Shen
- Department of Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
| | - Xiangguang An
- Department of Heart Center, Beijing Chao-Yang Hospital, Beijing, China
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76
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Norkienė I, Urbanaviciute I, Kezyte G, Vicka V, Jovaisa T. Impact of pre-operative health-related quality of life on outcomes after heart surgery. ANZ J Surg 2017; 88:332-336. [PMID: 28702944 DOI: 10.1111/ans.14061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/02/2017] [Accepted: 04/05/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Long-term improvement in health-related quality of life (HRQOL) is one of the most important outcomes of cardiac surgery. The aim of this study is to define the impact of perioperative patient and procedural variables on HRQOL dynamics, a year after cardiac surgery. METHODS Consecutive patients undergoing elective on-pump cardiac surgery were enrolled in this prospective observational cohort study. Patients completed the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire a day before surgery and once again a year after surgery. The effect size method was used to determine whether treatment resulted in the improvement of HRQOL. RESULTS A total of 67.3% of patients achieved long-term improvement in HRQOL. Significant negative association was identified between Physical and Mental Component Summary scores (PCS/MCS) and long-term outcomes. Pre-operative PCS were 40.7 ± 13.7 for improvers and 56.6 ± 14.4 for non-improvers; MCS were 45.8 ± 12.1 and 65.2 ± 13.7, respectively (P < 0.001 for all). There were no statistically significant differences in pre-operative risk factors, demographics, operative factors or post-operative variables between the two groups. CONCLUSION Among those completing this study, one in three patients did not experience long-term HRQOL improvements following cardiac surgery. Multivariate analysis confirmed that higher pre-operative PCS and MCS are independent predictors of worse HRQOL a year after surgery. Further research should focus on establishing the prevalence of this phenomenon worldwide and develop targeted interventions to improve long-term self-perceived quality of life for patients with relatively good pre-operative health.
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Affiliation(s)
- Ieva Norkienė
- Faculty of Medicine, Clinic of Anaesthesiology and Reanimatology, Vilnius University, Vilnius, Lithuania
| | - Indre Urbanaviciute
- Faculty of Medicine, Clinic of Anaesthesiology and Reanimatology, Vilnius University, Vilnius, Lithuania
| | - Greta Kezyte
- Faculty of Medicine, Clinic of Anaesthesiology and Reanimatology, Vilnius University, Vilnius, Lithuania
| | - Vaidas Vicka
- Faculty of Medicine, Clinic of Anaesthesiology and Reanimatology, Vilnius University, Vilnius, Lithuania
| | - Tomas Jovaisa
- Clinic of Anaesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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77
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Affiliation(s)
- Phillip J Tully
- Phillip J. Tully, psychologist, University of Adelaide, Australia.
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78
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Kaar JL, Luberto CM, Campbell KA, Huffman JC. Sleep, health behaviors, and behavioral interventions: Reducing the risk of cardiovascular disease in adults. World J Cardiol 2017; 9:396-406. [PMID: 28603586 PMCID: PMC5442407 DOI: 10.4330/wjc.v9.i5.396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/04/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
Numerous health behaviors, including physical activity, diet, smoking, and sleep, play a major role in preventing the development and progression of cardiovascular disease (CVD). Among these behaviors, sleep may play a pivotal role, yet it has been studied somewhat less than other behaviors and there have been few well-designed sleep intervention studies targeting CVD. Furthermore, despite the fact that these behaviors are often interrelated, interventions tend to focus on changing one health behavior rather than concurrently intervening on multiple behaviors. Psychological constructs from depression to positive affect may also have a major effect on these health behaviors and ultimately on CVD. In this review, we summarize the existing literature on the impact of sleep and other cardiac health behaviors on CVD onset and prognosis. We also describe interventions that may promote these behaviors, from established interventions such as motivational interviewing and cognitive behavioral therapy, to more novel approaches focused on mindfulness and other positive psychological constructs. Finally, we outline population-health-level care management approaches for patients with psychiatric conditions (e.g., depression) that may impact cardiac health, and discuss their potential utility in improving mental health, promoting health behaviors, and reducing CVD-related risk. Much work is still needed to better understand how sleep and other health behaviors may uniquely contribute to CVD risk, and additional high-quality studies of interventions designed to modify cardiac health behaviors are required to improve cardiovascular health in individuals and the population at large.
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79
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Dreyer RP, Dharmarajan K, Kennedy KF, Jones PG, Vaccarino V, Murugiah K, Nuti SV, Smolderen KG, Buchanan DM, Spertus JA, Krumholz HM. Sex Differences in 1-Year All-Cause Rehospitalization in Patients After Acute Myocardial Infarction: A Prospective Observational Study. Circulation 2017; 135:521-531. [PMID: 28153989 DOI: 10.1161/circulationaha.116.024993] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/13/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Compared with men, women are at higher risk of rehospitalization in the first month after discharge for acute myocardial infarction (AMI). However, it is unknown whether this risk extends to the full year and varies by age. Explanatory factors potentially mediating the relationship between sex and rehospitalization remain unexplored and are needed to reduce readmissions. The aim of this study was to assess sex differences and factors associated with 1-year rehospitalization rates after AMI. METHODS We recruited 3536 patients (33% women) ≥18 years of age hospitalized with AMI from 24 US centers into the TRIUMPH study (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status). Data were obtained by medical record abstraction and patient interviews, and a physician panel adjudicated hospitalizations within the first year after AMI. We compared sex differences in rehospitalization using a Cox proportional hazards model, following sequential adjustment for covariates and testing for an age-sex interaction. RESULTS One-year crude all-cause rehospitalization rates for women were significantly higher than men after AMI (hazard ratio, 1.29 for women; 95% confidence interval, 1.12-1.48). After adjustment for demographics and clinical factors, women had a persistent 26% higher risk of rehospitalization (hazard ratio, 1.26; 95% confidence interval, 1.08-1.47). However, after adjustment for health status and psychosocial factors (hazard ratio, 1.14; 95% confidence interval, 0.96-1.35), the association was attenuated. No significant age-sex interaction was found for 1-year rehospitalization, suggesting that the increased risk applied to both older and younger women. CONCLUSIONS Regardless of age, women have a higher risk of rehospitalization compared with men over the first year after AMI. Although the increased risk persisted after adjustment for clinical factors, the poorer health and psychosocial state of women attenuated the difference.
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Affiliation(s)
- Rachel P Dreyer
- From Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, CT (R.P.D., K.D., K.M., S.V.N., H.M.K.); Department of Emergency Medicine (R.P.D.), Section of Cardiovascular Medicine (K.D., K.M., S.V.N., H.M.K.), Yale School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute, Kansas City, MO (K.F.K., P.G.J., K.G.S., D.M.B., J.A.S.); School of Medicine, University of Missouri-Kansas City (P.G.J., K.G.S., D.M.B., J.A.S.); Department of Epidemiology (V.V.) and Department of Medicine, Division of Cardiology (V.V.), Emory University School of Public Health, Atlanta, GA; School of Medicine, Department of Biomedical & Health Informatics, University of Missouri-Kansas City (K.G.S); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.).
| | - Kumar Dharmarajan
- From Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, CT (R.P.D., K.D., K.M., S.V.N., H.M.K.); Department of Emergency Medicine (R.P.D.), Section of Cardiovascular Medicine (K.D., K.M., S.V.N., H.M.K.), Yale School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute, Kansas City, MO (K.F.K., P.G.J., K.G.S., D.M.B., J.A.S.); School of Medicine, University of Missouri-Kansas City (P.G.J., K.G.S., D.M.B., J.A.S.); Department of Epidemiology (V.V.) and Department of Medicine, Division of Cardiology (V.V.), Emory University School of Public Health, Atlanta, GA; School of Medicine, Department of Biomedical & Health Informatics, University of Missouri-Kansas City (K.G.S); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Kevin F Kennedy
- From Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, CT (R.P.D., K.D., K.M., S.V.N., H.M.K.); Department of Emergency Medicine (R.P.D.), Section of Cardiovascular Medicine (K.D., K.M., S.V.N., H.M.K.), Yale School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute, Kansas City, MO (K.F.K., P.G.J., K.G.S., D.M.B., J.A.S.); School of Medicine, University of Missouri-Kansas City (P.G.J., K.G.S., D.M.B., J.A.S.); Department of Epidemiology (V.V.) and Department of Medicine, Division of Cardiology (V.V.), Emory University School of Public Health, Atlanta, GA; School of Medicine, Department of Biomedical & Health Informatics, University of Missouri-Kansas City (K.G.S); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Philip G Jones
- From Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, CT (R.P.D., K.D., K.M., S.V.N., H.M.K.); Department of Emergency Medicine (R.P.D.), Section of Cardiovascular Medicine (K.D., K.M., S.V.N., H.M.K.), Yale School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute, Kansas City, MO (K.F.K., P.G.J., K.G.S., D.M.B., J.A.S.); School of Medicine, University of Missouri-Kansas City (P.G.J., K.G.S., D.M.B., J.A.S.); Department of Epidemiology (V.V.) and Department of Medicine, Division of Cardiology (V.V.), Emory University School of Public Health, Atlanta, GA; School of Medicine, Department of Biomedical & Health Informatics, University of Missouri-Kansas City (K.G.S); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Viola Vaccarino
- From Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, CT (R.P.D., K.D., K.M., S.V.N., H.M.K.); Department of Emergency Medicine (R.P.D.), Section of Cardiovascular Medicine (K.D., K.M., S.V.N., H.M.K.), Yale School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute, Kansas City, MO (K.F.K., P.G.J., K.G.S., D.M.B., J.A.S.); School of Medicine, University of Missouri-Kansas City (P.G.J., K.G.S., D.M.B., J.A.S.); Department of Epidemiology (V.V.) and Department of Medicine, Division of Cardiology (V.V.), Emory University School of Public Health, Atlanta, GA; School of Medicine, Department of Biomedical & Health Informatics, University of Missouri-Kansas City (K.G.S); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Karthik Murugiah
- From Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, CT (R.P.D., K.D., K.M., S.V.N., H.M.K.); Department of Emergency Medicine (R.P.D.), Section of Cardiovascular Medicine (K.D., K.M., S.V.N., H.M.K.), Yale School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute, Kansas City, MO (K.F.K., P.G.J., K.G.S., D.M.B., J.A.S.); School of Medicine, University of Missouri-Kansas City (P.G.J., K.G.S., D.M.B., J.A.S.); Department of Epidemiology (V.V.) and Department of Medicine, Division of Cardiology (V.V.), Emory University School of Public Health, Atlanta, GA; School of Medicine, Department of Biomedical & Health Informatics, University of Missouri-Kansas City (K.G.S); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Sudhakar V Nuti
- From Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, CT (R.P.D., K.D., K.M., S.V.N., H.M.K.); Department of Emergency Medicine (R.P.D.), Section of Cardiovascular Medicine (K.D., K.M., S.V.N., H.M.K.), Yale School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute, Kansas City, MO (K.F.K., P.G.J., K.G.S., D.M.B., J.A.S.); School of Medicine, University of Missouri-Kansas City (P.G.J., K.G.S., D.M.B., J.A.S.); Department of Epidemiology (V.V.) and Department of Medicine, Division of Cardiology (V.V.), Emory University School of Public Health, Atlanta, GA; School of Medicine, Department of Biomedical & Health Informatics, University of Missouri-Kansas City (K.G.S); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Kim G Smolderen
- From Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, CT (R.P.D., K.D., K.M., S.V.N., H.M.K.); Department of Emergency Medicine (R.P.D.), Section of Cardiovascular Medicine (K.D., K.M., S.V.N., H.M.K.), Yale School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute, Kansas City, MO (K.F.K., P.G.J., K.G.S., D.M.B., J.A.S.); School of Medicine, University of Missouri-Kansas City (P.G.J., K.G.S., D.M.B., J.A.S.); Department of Epidemiology (V.V.) and Department of Medicine, Division of Cardiology (V.V.), Emory University School of Public Health, Atlanta, GA; School of Medicine, Department of Biomedical & Health Informatics, University of Missouri-Kansas City (K.G.S); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Donna M Buchanan
- From Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, CT (R.P.D., K.D., K.M., S.V.N., H.M.K.); Department of Emergency Medicine (R.P.D.), Section of Cardiovascular Medicine (K.D., K.M., S.V.N., H.M.K.), Yale School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute, Kansas City, MO (K.F.K., P.G.J., K.G.S., D.M.B., J.A.S.); School of Medicine, University of Missouri-Kansas City (P.G.J., K.G.S., D.M.B., J.A.S.); Department of Epidemiology (V.V.) and Department of Medicine, Division of Cardiology (V.V.), Emory University School of Public Health, Atlanta, GA; School of Medicine, Department of Biomedical & Health Informatics, University of Missouri-Kansas City (K.G.S); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - John A Spertus
- From Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, CT (R.P.D., K.D., K.M., S.V.N., H.M.K.); Department of Emergency Medicine (R.P.D.), Section of Cardiovascular Medicine (K.D., K.M., S.V.N., H.M.K.), Yale School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute, Kansas City, MO (K.F.K., P.G.J., K.G.S., D.M.B., J.A.S.); School of Medicine, University of Missouri-Kansas City (P.G.J., K.G.S., D.M.B., J.A.S.); Department of Epidemiology (V.V.) and Department of Medicine, Division of Cardiology (V.V.), Emory University School of Public Health, Atlanta, GA; School of Medicine, Department of Biomedical & Health Informatics, University of Missouri-Kansas City (K.G.S); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Harlan M Krumholz
- From Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, CT (R.P.D., K.D., K.M., S.V.N., H.M.K.); Department of Emergency Medicine (R.P.D.), Section of Cardiovascular Medicine (K.D., K.M., S.V.N., H.M.K.), Yale School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute, Kansas City, MO (K.F.K., P.G.J., K.G.S., D.M.B., J.A.S.); School of Medicine, University of Missouri-Kansas City (P.G.J., K.G.S., D.M.B., J.A.S.); Department of Epidemiology (V.V.) and Department of Medicine, Division of Cardiology (V.V.), Emory University School of Public Health, Atlanta, GA; School of Medicine, Department of Biomedical & Health Informatics, University of Missouri-Kansas City (K.G.S); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
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Liang F, Ma X, Zhao L, Xing C, Li X, Zhao D, Hu DY, Hu S, Wang W, Han L, Cao S, Liu H, Bian Z. Evaluation of Multidisciplinary Collaborative Care in Patients with Acute Coronary Syndrome and Depression and/or Anxiety Disorders. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2017.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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81
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Shapiro PA. Psychiatric Aspects of Heart Disease (and Cardiac Aspects of Psychiatric Disease) in Critical Care. Crit Care Clin 2017; 33:619-634. [PMID: 28601137 DOI: 10.1016/j.ccc.2017.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Strong emotional reactions are common in patients admitted to cardiac critical care; only some are pathological. Cardiac critical care and associated technologies are associated with predictable psychiatric problems. Many occur as secondary complications of the medical status of the patient, which must be carefully assessed. Depression is common in patients with coronary disease and also for patients with heart failure; treatment is helpful, but persistent depression is associated with elevated morbidity and mortality. Preexisting psychiatric disorders may predispose to heart disease, and they and their treatment may affect critical care management.
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Affiliation(s)
- Peter A Shapiro
- Department of Psychiatry, Columbia University Medical Center, College of Physicians and Surgeons, Columbia University, 622 West 168 Street Box 427, New York, NY 10032, USA; Consultation-Liaison Psychiatry Service, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168 Street, New York, NY 10032, USA.
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Razmjoee N, Ebadi A, Asadi-Lari M, Hosseini M. Does a “continuous care model” affect the quality of life of patients undergoing coronary artery bypass grafting? JOURNAL OF VASCULAR NURSING 2017; 35:21-26. [DOI: 10.1016/j.jvn.2016.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/06/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022]
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83
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Clinical effectiveness of individual patient education in heart surgery patients: A systematic review and meta-analysis. Int J Nurs Stud 2017; 65:44-53. [DOI: 10.1016/j.ijnurstu.2016.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/01/2016] [Accepted: 11/04/2016] [Indexed: 11/19/2022]
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84
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Rossom RC, Solberg LI, Magnan S, Crain AL, Beck A, Coleman KJ, Katzelnick D, Williams MD, Neely C, Ohnsorg K, Whitebird R, Brandenfels E, Pollock B, Ferguson R, Williams S, Unützer J. Impact of a national collaborative care initiative for patients with depression and diabetes or cardiovascular disease. Gen Hosp Psychiatry 2017; 44:77-85. [PMID: 27558106 DOI: 10.1016/j.genhosppsych.2016.05.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The spread of evidence-based care is an important challenge in healthcare. We evaluated spread of an evidence-based large-scale multisite collaborative care model for patients with depression and diabetes and/or cardiovascular disease (COMPASS). METHODS Primary care patients with depression and comorbid diabetes or cardiovascular disease were recruited. Collaborative care teams used care management tracking systems and systematic case reviews to track and intensify treatment for patients not improving. Targeted outcomes were depression remission and response (assessed with the Patient Health Questionnaire-9) and control of diabetes (assessed by HbA1c) and blood pressure. Patients and clinicians were surveyed about satisfaction with care. RESULTS Eighteen care systems and 172 clinics enrolled 3609 patients across the US. Of those with uncontrolled disease at enrollment, 40% achieved depression remission or response, 23% glucose control and 58% blood pressure control during a mean follow-up of 11 months. There were large variations in outcomes across medical groups. Patients and clinicians were satisfied with COMPASS care. CONCLUSIONS COMPASS was successfully spread across diverse care systems and demonstrated improved outcomes for complex patients with previously uncontrolled chronic disease. Future large-scale implementation projects should create robust processes to identify and reduce expected variation in implementation to consistently provide improved care.
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Affiliation(s)
- Rebecca C Rossom
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425.
| | - Leif I Solberg
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425
| | - Sanne Magnan
- Institute for Clinical Systems Improvement, 8009 34th Ave. S., Suite 1200, Bloomington, MN, 55425-1624
| | - A Lauren Crain
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, P.O. Box 378066, Denver, CO, 80237-8066
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA, 91101-2453
| | - David Katzelnick
- Mayo Clinic, Psychiatry and Psychology Division of Integrated Behavioral Health, 200 First St. SW, Rochester, MN, 55905
| | - Mark D Williams
- Mayo Clinic, Psychiatry and Psychology Division of Integrated Behavioral Health, 200 First St. SW, Rochester, MN, 55905
| | - Claire Neely
- Institute for Clinical Systems Improvement, 8009 34th Ave. S., Suite 1200, Bloomington, MN, 55425-1624
| | - Kris Ohnsorg
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425
| | - Robin Whitebird
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425; University of St. Thomas, School of Social Work, 2115 Summit Ave, St. Paul, MN, 55105
| | - Emily Brandenfels
- Community Health Plan of Washington, 720 Olive Way, Suite 300, Seattle, WA, 98101-1830
| | - Betsy Pollock
- Mount Auburn Cambridge Independent Practice Association, 1380 Soldiers Field Rd., Floor 2, Brighton, MA, 02135-1023
| | - Robert Ferguson
- Pittsburgh Regional Health Initiative, 650 Smithfield St., Centre City Tower, Suite 2400, Pittsburgh, PA, 15222-3900
| | - Steve Williams
- Michigan Center for Clinical Systems Improvement, 233 E. Fulton St., Suite 20, Grand Rapids, MI, 49503-3261
| | - Jürgen Unützer
- University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560
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85
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Celano CM, Villegas A, Albanese A, Huffman JC. Heart Failure: Psychological and Pharmacological Considerations. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20161102-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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86
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Koblauch H, Reinhardt SM, Lissau W, Jensen PL. The effect of telepsychiatric modalities on reduction of readmissions in psychiatric settings: A systematic review. J Telemed Telecare 2016; 24:31-36. [PMID: 27663681 PMCID: PMC5768249 DOI: 10.1177/1357633x16670285] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Introduction Telepsychiatric modalities are used widely in the treatment of many mental illnesses. It has also been proposed that telepsychiatric modalities could be a way to reduce readmissions. The purpose of the study was to conduct a systematic review of the literature on the effects of telepsychiatric modalities on readmissions in psychiatric settings. Methods We conducted a systematic literature search in MEDLINE, CINAHL, Embase, Cochrane, PsycINFO and Joanna Briggs databases in October 2015. Inclusion criteria were (a) patients with a psychiatric diagnosis, (b) telepsychiatric interventions and (c) an outcome related to readmission. Results The database search identified 218 potential studies, of which eight were eligible for the review. Studies were of varying quality and there was a tendency towards low-quality studies (five studies) which found positive outcomes regarding readmission, whereas the more methodological sound studies (three studies) found no effect of telepsychiatric modalities on readmission rates. Discussion Previous studies have proven the effectiveness of telepsychiatric modalities in the treatment of various mental illnesses. However, in the present systematic review we were unable to find an effect of telepsychiatric modalities on the rate of readmission. Some studies found a reduced rate of readmissions, but the poor methodological quality make the findings questionable. At the present time there is no evidence to support the use of telepsychiatry due to heterogeneous interventions, heterogeneous patient groups and lack of high-quality studies.
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Affiliation(s)
- Henrik Koblauch
- 1 Research and Development, University College Capital, Denmark.,2 Physiotherapy Programme, University College Capital, Denmark
| | - Sasha M Reinhardt
- 1 Research and Development, University College Capital, Denmark.,3 Nursing Programme, University College Capital, Denmark
| | - Waltraut Lissau
- 1 Research and Development, University College Capital, Denmark.,3 Nursing Programme, University College Capital, Denmark
| | - Pia-Lis Jensen
- 1 Research and Development, University College Capital, Denmark.,3 Nursing Programme, University College Capital, Denmark
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Rovai D, Giannessi D, Andreassi MG, Gentili C, Pingitore A, Glauber M, Gemignani A. Mind injuries after cardiac surgery. J Cardiovasc Med (Hagerstown) 2016; 16:844-51. [PMID: 24933202 DOI: 10.2459/jcm.0000000000000133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
After cardiac surgery, delirium, cognitive dysfunction, depression, or anxiety disorders frequently occur, and profoundly affect patients' prognosis and quality of life. This narrative review focuses on the main clinical presentations of cognitive and psychological problems ('mind injuries') that occur postoperatively in absence of ascertainable focal neurologic deficits, exploring their pathophysiological mechanisms and possible strategies for prevention and treatment. Postoperative cognitive dysfunction is a potentially devastating complication that can involve several mechanisms and several predisposing, intraoperative, and postoperative risk factors, which can result in or be associated to cerebral microvascular damage. Postoperative depression is influenced by genetic or psychosocial predisposing factors, by neuroendocrine activation, and by the release of several pro-inflammatory factors. The net effect of these changes is neuroinflammation. These complex biochemical alterations, along with an aspecific response to stressful life events, might target the function of several brain areas, which are thought to represent a trigger factor for the onset of depression.
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Affiliation(s)
- Daniele Rovai
- aCNR, Institute of Clinical Physiology bBiomedicine, CNR, Institute of Clinical Physiology cClinical Psychology, Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa dCardiothoracic Department, Fondazione Toscana G. Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
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88
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Poole L, Ronaldson A, Kidd T, Leigh E, Jahangiri M, Steptoe A. Pre-surgical depression and anxiety and recovery following coronary artery bypass graft surgery. J Behav Med 2016; 40:249-258. [PMID: 27552993 PMCID: PMC5332487 DOI: 10.1007/s10865-016-9775-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
Abstract
We aimed to explore the combined contribution of pre-surgical depression and anxiety symptoms for recovery following coronary artery bypass graft (CABG) using data from 251 participants. Participants were assessed prior to surgery for depression and anxiety symptoms and followed up at 12 months to assess pain and physical symptoms, while hospital emergency admissions and death/major adverse cardiac events (MACE) were monitored on average 2.68 years after CABG. After controlling for covariates, baseline anxiety symptoms, but not depression, were associated with greater pain (β = 0.231, p = 0.014) and greater physical symptoms (β = 0.194, p = 0.034) 12 months after surgery. On the other hand, after controlling for covariates, baseline depression symptoms, but not anxiety, were associated with greater odds of having an emergency admission (OR 1.088, CI 1.010–1.171, p = 0.027) and greater hazard of death/MACE (HR 1.137, CI 1.042–1.240, p = 0.004). These findings point to different pathways linking mood symptoms with recovery after CABG surgery.
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Affiliation(s)
- Lydia Poole
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Amy Ronaldson
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Tara Kidd
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Elizabeth Leigh
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St George's Hospital, University of London, Blackshaw Road, London, SW17 0QT, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
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Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women. Neurosci Biobehav Rev 2016; 74:297-309. [PMID: 27496672 DOI: 10.1016/j.neubiorev.2016.04.023] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/15/2016] [Accepted: 04/20/2016] [Indexed: 02/08/2023]
Abstract
Women have more of the stress-related behavioral profile that has been linked to cardiovascular disease than men. For example, women double the rates of stress-related mental disorders such as depression and posttraumatic stress disorder (PTSD) than men, and have higher rates of exposure to adversity early in life. This profile may increase women's long-term risk of cardiometabolic conditions linked to stress, especially coronary heart disease (CHD). In addition to having a higher prevalence of psychosocial stressors, women may be more vulnerable to the adverse effects of these stressors on CHD, perhaps through altered neurobiological physiology. Emerging data suggest that young women are disproportionally susceptible to the adverse effects of stress on the risk of cardiovascular disease, both in terms of initiating the disease as well as worsening the prognosis in women who have already exhibited symptoms of the disease. Women's potential vulnerability to psychosocial stress could also help explain their higher propensity toward abnormal coronary vasomotion and microvascular disease compared with men.
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Abstract
Depression in patients who have had a myocardial infarction is an important clinical problem because it is extremely common and because the comorbidity complicates depression treatment and worsens the cardiovascular prognosis. Studies of psychotherapy, exercise, pharmacotherapy, and collaborative care demonstrate that effective treatment of depression is possible but the strength of the effects seen in most studies is low, and cardiovascular and all-cause morbidity and mortality benefits have not been proven. Recent collaborative care studies have had promising outcomes. For pharmacotherapy, side effects, including bleeding and arrhythmia risks, require special attention. Recovery from depression is associated with better long-term cardiovascular prognosis, while treatment per se is not.
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91
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A Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD): Results of an Observer-Blinded, Multicenter, Randomized Trial in Depressed Patients With Coronary Artery Disease. Psychosom Med 2016; 78:704-15. [PMID: 27187851 DOI: 10.1097/psy.0000000000000332] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Depression predicts adverse prognosis in patients with coronary artery disease (CAD), but previous treatment trials yielded mixed results. We tested the hypothesis that stepwise psychotherapy improves depressive symptoms more than simple information. METHODS In a multicenter trial, we randomized 570 CAD patients scoring higher than 7 on the Hospital Anxiety and Depression Scale-depression subscale to usual care plus either one information session (UC-IS) or stepwise psychotherapy (UC-PT). UC-PT patients received three individual psychotherapy sessions. Those still depressed were offered group psychotherapy (25 sessions). The primary outcome was changed in the Hospital Anxiety and Depression Scale-depression scores from baseline to 18 months. Preplanned subgroup analyses examined whether treatment responses differed by patients' sex and personality factors (Type D). RESULTS The mean (standard deviation) depression scores declined from 10.4 (2.5) to 8.7 (4.1) at 18 months in UC-PT and from 10.4 (2.5) to 8.9 (3.9) in UC-IS (both p < .001). There was no significant group difference in change of depressive symptoms (group-by-time effect, p = .90). Preplanned subgroup analyses revealed no differences in treatment effects between men versus women (ptreatment-by-sex interaction = .799) but a significant treatment-by-Type D interaction on change in depressive symptoms (p = .026) with a trend for stronger improvement with UC-PT than UC-IS in Type D patients (n = 341, p = .057) and no such difference in improvement in patients without Type D (n = 227, p = .54). CONCLUSIONS Stepwise psychotherapy failed to improve depressive symptoms in CAD patients more than UC-IS. The intervention might be beneficial for depressed CAD patients with Type D personality. However, this finding requires further study. TRIAL REGISTRATION www.clinicaltrials.gov NCT00705965; www.isrctn.com ISRCTN76240576.
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92
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Bowyer JL, Tully PJ, Ganesan AN, Chahadi FK, Singleton CB, McGavigan AD. A Randomised Controlled Trial on the Effect of Nurse-Led Educational Intervention at the Time of Catheter Ablation for Atrial Fibrillation on Quality of Life, Symptom Severity and Rehospitalisation. Heart Lung Circ 2016; 26:73-81. [PMID: 27423977 DOI: 10.1016/j.hlc.2016.04.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/12/2016] [Accepted: 04/23/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Atrial Fibrillation (AF) is a common condition associated with impaired quality of life (QOL) and recurrent hospitalisation. Catheter ablation for AF is a well-established treatment for symptomatic patients despite medical therapy. We sought to examine the effect of point specific nurse-led education on QOL, AF symptomatology and readmission rate post AF ablation. METHODS Forty-one patients undergoing AF ablation were randomised to Nurse Intervention (NI) versus Control (C), n=22 vs. 19. Both groups were well matched with respect to age, sex and AF subtype. All patients completed SF36 and AF Symptom Checklist, Frequency and Severity Scale questionnaires at baseline and six months post ablation. The NI group underwent nurse education on admission, prior to discharge, and with telephone contact. RESULTS Baseline SF-36 and AF Symptom Checklist, Frequency and Severity scores were similar. The NI group showed significant differences compared to Control with respect to higher QOL on the SF-36 score of Physical Functioning and Vitality at six months. There were significant improvements in seven components of the AF Symptom Checklist, Frequency and Severity at six months in the NI group with a trend in a further seven. There was no difference in AF related hospital readmissions at six months between C and NI groups (10.5% vs. 13.6%, p=ns). CONCLUSION Nurse-led education at time of AF ablation is associated with improved QOL and reduced symptom frequency and severity compared to usual care.
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Affiliation(s)
- John L Bowyer
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Phillip J Tully
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia; Faculty of Medicine, Flinders University, Adelaide, SA, Australia
| | - Anand N Ganesan
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia; Faculty of Medicine, Flinders University, Adelaide, SA, Australia
| | - Fahd K Chahadi
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Cameron B Singleton
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Andrew D McGavigan
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia; Faculty of Medicine, Flinders University, Adelaide, SA, Australia.
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93
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Carney RM, Freedland KE, Steinmeyer BC, Rubin EH, Ewald G. Collaborative care for depression symptoms in an outpatient cardiology setting: A randomized clinical trial. Int J Cardiol 2016; 219:164-71. [PMID: 27327502 DOI: 10.1016/j.ijcard.2016.06.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/19/2016] [Accepted: 06/12/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Depression is a risk factor for morbidity and mortality in patients with coronary heart disease. Finding effective methods for identifying and treating depression in these patients is a high priority. The purpose of this study was to determine whether collaborative care (CC) for patients who screen positive for depression during an outpatient cardiology visit results in greater improvement in depression symptoms and better medical outcomes than seen in patients who screen positive for depression but receive only usual care (UC). METHODS Two hundred-one patients seen in an outpatient cardiology clinic who screened positive for depression during an outpatient visit were randomized to receive either CC or UC. Recommendations for depression treatment and ongoing support and monitoring of depression symptoms were provided to CC patients and their primary care physicians (PCPs) for up to 6months. RESULTS There were no differences between the arms in mean Beck Depression Inventory-II scores(CC, 15.9; UC, 17.4; p=.45) or in depression remission rates(CC, 32.5%; UC, 26.2%; p=0.34) after 6months, or in the number of hospitalizations after 12months (p=0.73). There were fewer deaths among the CC (1/100) than UC patients (8/101) (p=0.03). CONCLUSIONS This trial did not show that CC produces better depression outcomes than UC. Screening led to a higher rate of depression treatment than was expected in the UC group, and delays in obtaining depression treatment from PCPs may have reduced treatment effectiveness for the CC patients. A different strategy for depression treatment following screening in outpatient cardiology services is needed.
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Affiliation(s)
- Robert M Carney
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian C Steinmeyer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Eugene H Rubin
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory Ewald
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Patron E, Messerotti Benvenuti S, Palomba D. Preoperative biomedical risk and depressive symptoms are differently associated with reduced health-related quality of life in patients 1year after cardiac surgery. Gen Hosp Psychiatry 2016; 40:47-54. [PMID: 26947593 DOI: 10.1016/j.genhosppsych.2016.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/04/2016] [Accepted: 02/06/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether preoperative biomedical risk and depressive symptoms were associated with physical and mental components of health-related quality of life (HRQoL) in patients 1year after cardiac surgery. METHOD Seventy-five patients completed a psychological evaluation, including the Center for Epidemiological Study of Depression scale, the 12-item Short-Form Physical Component Scale (SF-12-PCS) and Mental Component Scale (SF-12-MCS), the Instrumental Activities of Daily Living questionnaire for depressive symptoms and HRQoL, respectively, before surgery and at 1-year follow-up. RESULTS Preoperative depressive symptoms predicted the SF-12-PCS (beta=-.22, P<.05) and SF-12-MCS (beta=-.30, P<.04) scores in patients 1year after cardiac surgery, whereas the European System for Cardiac Operative Risk Evaluation was associated with SF-12-PCS (beta=-.28, P<.02), but not SF-12-MCS (beta=.01, P=.97) scores postoperatively. CONCLUSIONS The current findings showed that preoperative depressive symptoms are associated with poor physical and mental components of HRQoL, whereas high biomedical risk predicts reduced physical, but not mental, functioning in patients postoperatively. This study suggests that a preoperative assessment of depressive symptoms in addition to the evaluation of common biomedical risk factors is essential to anticipate which patients are likely to show poor HRQoL after cardiac surgery.
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Affiliation(s)
- Elisabetta Patron
- Department of General Psychology, University of Padova, Via Venezia, 8-35131, Padova, Italy.
| | | | - Daniela Palomba
- Department of General Psychology, University of Padova, Via Venezia, 8-35131, Padova, Italy.
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95
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Schuster JM, Belnap BH, Roth LH, Rollman BL. The Checklist Manifesto in action: integrating depression treatment into routine cardiac care. Gen Hosp Psychiatry 2016; 40:1-3. [PMID: 26916974 DOI: 10.1016/j.genhosppsych.2016.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 01/15/2016] [Accepted: 01/18/2016] [Indexed: 11/19/2022]
Affiliation(s)
- James M Schuster
- University of Pittsburgh Medical Center Insurance Services Division, Pittsburgh, PA
| | - Bea Herbeck Belnap
- Division of General Internal Medicine, Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Loren H Roth
- University of Pittsburgh Medical Center Insurance Services Division, Pittsburgh, PA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Bruce L Rollman
- Division of General Internal Medicine, Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Zatzick DF, Russo J, Darnell D, Chambers DA, Palinkas L, Van Eaton E, Wang J, Ingraham LM, Guiney R, Heagerty P, Comstock B, Whiteside LK, Jurkovich G. An effectiveness-implementation hybrid trial study protocol targeting posttraumatic stress disorder and comorbidity. Implement Sci 2016; 11:58. [PMID: 27130272 PMCID: PMC4851808 DOI: 10.1186/s13012-016-0424-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/20/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Each year in the USA, 1.5-2.5 million Americans are so severely injured that they require inpatient hospitalization. Multiple conditions including posttraumatic stress disorder (PTSD), alcohol and drug use problems, depression, and chronic medical conditions are endemic among physical trauma survivors with and without traumatic brain injuries. METHODS/DESIGN The trauma survivors outcomes and support (TSOS) effectiveness-implementation hybrid trial is designed to test the delivery of high-quality screening and intervention for PTSD and comorbidities across 24 US level I trauma center sites. The pragmatic trial aims to recruit 960 patients. The TSOS investigation employs a stepped wedge cluster randomized design in which sites are randomized sequentially to initiate the intervention. Patients identified by a 10-domain electronic health record screen as high risk for PTSD are formally assessed with the PTSD Checklist for study entry. Patients randomized to the intervention condition will receive stepped collaborative care, while patients randomized to the control condition will receive enhanced usual care. The intervention training begins with a 1-day on-site workshop in the collaborative care intervention core elements that include care management, medication, cognitive behavioral therapy, and motivational-interviewing elements targeting PTSD and comorbidity. The training is followed by site supervision from the study team. The investigation aims to determine if intervention patients demonstrate significant reductions in PTSD and depressive symptoms, suicidal ideation, alcohol consumption, and improvements in physical function when compared to control patients. The study uses implementation science conceptual frameworks to evaluate the uptake of the intervention model. At the completion of the pragmatic trial, results will be presented at an American College of Surgeons' policy summit. Twenty-four representative US level I trauma centers have been selected for the study, and the protocol is being rolled out nationally. DISCUSSION The TSOS pragmatic trial simultaneously aims to establish the effectiveness of the collaborative care intervention targeting PTSD and comorbidity while also addressing sustainable implementation through American College of Surgeons' regulatory policy. The TSOS effectiveness-implementation hybrid design highlights the importance of partnerships with professional societies that can provide regulatory mandates targeting enhanced health care system sustainability of pragmatic trial results. TRIAL REGISTRATION ClinicalTrials.gov NCT02655354 . Registered 27 July 2015.
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Affiliation(s)
- Douglas F Zatzick
- Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA.
- Harborview Injury Prevention Research Center, University of Washington, 325 Ninth Ave, Box 359960, Seattle, WA, 98104, USA.
| | - Joan Russo
- Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Doyanne Darnell
- Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, BG 9609 MSC 9760, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA
| | - Lawrence Palinkas
- School of Social Work, University of Southern California, Montgomery Ross Fisher Building, Room 339, Los Angeles, CA, 90089, USA
| | - Erik Van Eaton
- Department of Surgery, University of Washington, 325 Ninth Ave, Box 359796, Seattle, WA, 98104, USA
| | - Jin Wang
- Harborview Injury Prevention Research Center, University of Washington, 325 Ninth Ave, Box 359960, Seattle, WA, 98104, USA
| | - Leah M Ingraham
- Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Roxanne Guiney
- Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington, 1705 NE Pacific St, Box 357232, Seattle, WA, 98195, USA
| | - Bryan Comstock
- Department of Biostatistics, University of Washington, 1705 NE Pacific St, Box 357232, Seattle, WA, 98195, USA
| | - Lauren K Whiteside
- Division of Emergency Medicine, University of Washington, 25 Ninth Ave, Box 359702, Seattle, WA, 98104, USA
| | - Gregory Jurkovich
- Department of Surgery, University of California in Davis, 2221 Stockton Blvd, Cypress #3111, Sacramento, CA, 95817, USA
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Mahdizadeh M, Alavi M, Ghazavi Z. The effect of education based on the main concepts of logotherapy approach on the quality of life in patients after coronary artery bypass grafting surgery. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:14-9. [PMID: 26985218 PMCID: PMC4776556 DOI: 10.4103/1735-9066.174752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Improving the patients’ quality of life (QOL) after coronary artery bypass grafting (CABG) is one of the main concerns of the treatment team. Educational interventions may affect the aspects of QOL in various ways. The present study aimed to investigate the effect of education based on the main concepts of logotherapy approach on the CABG patients’ quality of life. Materials and Methods: In this quasi-experimental study, a convenient sample of 67 patients who had undergone CABG in Isfahan Chamran hospital were randomly allocated to two groups of experimental (n = 35) and control (n = 32). While the control group received routine care, the experiment group benefitted from logotherapy-based education program (six 90-min sessions, twice a week). SF-36 questionnaire was completed by both two groups (before and 1 month after intervention). Descriptive and inferential statistical tests (consisting of independent t-test) were employed to analyze data in SPSS version 13. Results: The pre-test mean total score of SF-36 questionnaire and also the mean scores of its eight dimensions were not significantly different between the two groups. The post-test mean score change [Standard Error (SE)] in the intervention group was 24.95 (3) and in the control group was 9.27 (0.82). There were significant differences between the two groups (P < 0.001). Moreover, the mean scores of six dimensions of QOL (vitality, bodily pain, general health, emotional role, social functioning, and mental health) changed significantly in the intervention group. Conclusions: Our findings indicated that the intervention has improved the patients’ QOL after CABG. Integration of such an intervention in these patients’ rehabilitation programs is recommended.
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Affiliation(s)
- Mostafa Mahdizadeh
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mousa Alavi
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Ghazavi
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Tully PJ, Baumeister H, Bennetts JS, Rice GD, Baker RA. Depression screening after cardiac surgery: A six month longitudinal follow up for cardiac events, hospital readmissions, quality of life and mental health. Int J Cardiol 2016; 206:44-50. [DOI: 10.1016/j.ijcard.2016.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/14/2015] [Accepted: 01/01/2016] [Indexed: 01/22/2023]
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99
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Depression and Anxiety following Coronary Artery Bypass Graft: Current Indian Scenario. Cardiol Res Pract 2016; 2016:2345184. [PMID: 27034884 PMCID: PMC4789419 DOI: 10.1155/2016/2345184] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/26/2016] [Accepted: 02/03/2016] [Indexed: 01/18/2023] Open
Abstract
Epidemiological studies have shown a high prevalence of coronary artery disease among the Indian Population. Due to increasing availability and affordability of tertiary care in many parts of India, carefully selected patients undergo coronary artery bypass surgery to improve cardiac function. However, the procedure is commonly associated with depression and anxiety which can adversely affect overall prognosis. The objective of this review is to highlight early identifiable symptoms of depression and anxiety following coronary artery bypass graft (CABG) in Indian context so as to facilitate prompt intervention for better outcome. The current review was able to establish firm evidence in support of screening for depression and anxiety following CABG. Management of depression and anxiety following CABG is briefly reviewed.
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100
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Bauer MS, Krawczyk L, Miller CJ, Abel E, Osser DN, Franz A, Brandt C, Rooney M, Fleming J, Godleski L. Team-Based Telecare for Bipolar Disorder. Telemed J E Health 2016; 22:855-864. [PMID: 26906927 DOI: 10.1089/tmj.2015.0255] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Numerous randomized controlled trials indicate that collaborative chronic care models improve outcome in a wide variety of mental health conditions, including bipolar disorder. However, their spread into clinical practice is limited by the need for a critical mass of patients and specialty providers in the same locale. Clinical videoconferencing has the potential to overcome these geographic limitations. MATERIALS AND METHODS A videoconference-based collaborative care program for bipolar disorder was implemented in the Department of Veterans Affairs. Program evaluation assessed experience with the first 400 participants, guided by five domains specified by the American Telemedicine Association: treatment engagement, including identification of subpopulations at risk for not being reached; participation in treatment; clinical impact; patient safety; and quality of care. RESULTS Participation rates resembled those for facility-based collaborative care. No participant characteristics predicted nonengagement. Program completers demonstrated significant improvements in several clinical indices, without evidence of compromise in patient safety. Guideline-based quality of care assessment after 1 year indicated increased lithium use, decreased antidepressant use, and increased prazosin use in individuals with comorbid post-traumatic stress disorder, but no impact on already high rates of lithium serum level monitoring. DISCUSSION Clinical videoconferencing can extend the reach of collaborative care models for bipolar disorder. The next step involves assessment of the videoconference-based collaborative care for other serious mental health conditions, investigation of barriers and facilitators of broad implementation of the model, and evaluation of the business case for deployment and sustainability in clinical practice.
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Affiliation(s)
- Mark S Bauer
- 1 VA Center for Healthcare Organization and Implementation Research , Boston, Massachusetts.,2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts
| | - Lois Krawczyk
- 2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts
| | - Christopher J Miller
- 1 VA Center for Healthcare Organization and Implementation Research , Boston, Massachusetts.,2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts
| | - Erica Abel
- 3 Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut
| | - David N Osser
- 2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts
| | - Aleda Franz
- 3 Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut
| | - Cynthia Brandt
- 3 Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut
| | - Meghan Rooney
- 4 Hunter Holmes McGuire VA Medical Center , Richmond, Virginia
| | - Jerry Fleming
- 2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts
| | - Linda Godleski
- 3 Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut.,5 VA Central Office , Office of Telehealth Services, West Haven, Connecticut
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