Centralized, Stepped, Patient Preference-Based Treatment for Patients With Post-Acute Coronary Syndrome Depression CODIACS Vanguard Randomized Controlled Trial
Centralized, Stepped, Patient Preference-Based Treatment for Patients With Post-Acute Coronary Syndrome Depression CODIACS Vanguard Randomized Controlled Trial
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DOI：
10.1001/jamainternmed.2013.915
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发表时间：
2013-06-10
影响因子：
39
通讯作者：
Ye, Siqin
中科院分区：
文献类型：
--
作者：
Davidson, Karina W.;Bigger, J. Thomas;Ye, Siqin
重要性：关于急性冠脉综合征（ACS）后抑郁症是否可以成功治疗以及这样做的成本和收益仍然存在争议。目的：确定提供ACS后抑郁症护理对抑郁症状和医疗保健成本的影响。设计：多中心随机对照试验。设置：从美国的2个私人和5个学术门诊中心招募患者。参与者：共有150名抑郁症状加重的患者（贝克抑郁量表[BDI]评分>= 10）ACS后2至6个月，在2010年3月18日至2012年1月9日期间招募。患者被随机分配到6个月的集中抑郁症护理（患者偏好通过电话或互联网、药物治疗或两者都不给予解决问题的治疗），每6 - 8周进行一次步进（积极治疗组; n=73），或在医生告知患者抑郁症状后接受当地确定的抑郁症治疗（常规护理组; n=77）。主要结果测量：6个月内抑郁症状的变化和总医疗费用。积极治疗组的抑郁症状比常规治疗组明显减少（两组间的差异变化，-3.5 BDI点; 95% CI，-6.1至-0.7; P= 0.01）。虽然积极治疗的精神卫生保健估计费用高于常规治疗，但总体卫生保健估计费用没有显著差异（差异调整混杂因素，-325美元; 95%CI，-2639至1989美元; P=.78）。结论：对于ACS后抑郁患者，积极治疗对抑郁症状有实质性的有益影响。这种抑郁症护理是可行的、有效的，并且可能在6个月内实现成本中性;因此，应该在大型第三阶段务实试验中进行测试。
Importance: Controversy remains about whether depression can be successfully managed after acute coronary syndrome (ACS) and the costs and benefits of doing so.Objective: To determine the effects of providing post-ACS depression care on depressive symptoms and health care costs.Design: Multicenter randomized controlled trial.Setting: Patients were recruited from 2 private and 5 academic ambulatory centers across the United States.Participants: A total of 150 patients with elevated depressive symptoms (Beck Depression Inventory [BDI] score >= 10) 2 to 6 months after an ACS, recruited between March 18, 2010, and January 9, 2012.Interventions: Patients were randomized to 6 months of centralized depression care (patient preference for problem-solving treatment given via telephone or the Internet, pharmacotherapy, both, or neither), stepped every 6 to 8 weeks (active treatment group; n=73), or to locally determined depression care after physician notification about the patient's depressive symptoms (usual care group; n=77).Main Outcome Measures: Change in depressive symptoms during 6 months and total health care costs.Results: Depressive symptoms decreased significantly more in the active treatment group than in the usual care group (differential change between groups, -3.5 BDI points; 95% CI, -6.1 to -0.7; P=.01). Although mental health care estimated costs were higher for active treatment than for usual care, overall health care estimated costs were not significantly different (difference adjusting for confounding, -$325; 95% CI, -$2639 to $1989; P=.78).Conclusions: For patients with post-ACS depression, active treatment had a substantial beneficial effect on depressive symptoms. This kind of depression care is feasible, effective, and may be cost-neutral within 6 months; therefore, it should be tested in a large phase 3 pragmatic trial.