The effect of enhanced depression care on adherence to risk-reducing behaviors after acute coronary syndromes: Findings from the COPES trial
The effect of enhanced depression care on adherence to risk-reducing behaviors after acute coronary syndromes: Findings from the COPES trial
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DOI：
10.1016/j.ahj.2012.07.024
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发表时间：
2012-10-01
影响因子：
4.8
通讯作者：
Davidson, Karina W.
中科院分区：
文献类型：
--
作者：
Kronish, Ian M.;Rieckmann, Nina;Davidson, Karina W.
背景 急性冠脉综合征（ACS）后出现抑郁症与预后较差和对降低风险行为的依从性较低有关。我们之前报道过，加强抑郁症护理干预可以减少抑郁症症状和主要不良心脏事件。本研究评估抑郁干预对健康行为和血压控制的影响。 方法 2005 年至 2008 年间，157 名在 ACS 后 3 个月仍持续抑郁的患者被随机分配接受为期 6 个月的抑郁干预（最初患者偏好问题解决疗法和/或药物治疗，随后进行阶梯式护理；80 名患者）或常规护理（77 名患者）。在随机分组时以及 2、4 和 6 个月后，患者被询问是否 (1) 错过服用阿司匹林； (2) 遵循有益心脏健康的饮食习惯； (3)定期锻炼身体； (4) 用过的烟草制品。在随机分组前和 6 个月后测量血压。 结果 在干预结束时，与坚持服用阿司匹林（+3% 对比 -1%，P = .23）、遵循健康饮食（+10% 对比 +8%，P = .39）、定期锻炼（+5% 对比 +4%，P = .65）、戒烟的对照组患者相比，干预百分比没有显着改善 （-3% 与-1%，P = .77），或血压得到控制（+6% 与+16%，P = .26）。结论 尽管改善了抑郁症，但与常规护理相比，ACS 后加强抑郁症护理并没有改善健康行为或血压控制。需要进行研究来测试在加强抑郁症护理的基础上添加依从性干预措施是否可以改善 ACS 后抑郁症患者的依从性和心血管预后。 （Am Heart J 2012；164：524-9。）
Background The presence of depression after an acute coronary syndrome (ACS) is associated with worse prognosis and lower adherence to risk-reducing behaviors. We reported earlier that an enhanced depression care intervention reduces depression symptoms and major adverse cardiac events. This study evaluates the impact of the depression intervention on health behavior and blood pressure control.Methods Between 2005 and 2008, 157 patients who remained persistently depressed 3 months after ACS were randomized to a 6-month depression intervention (initial patient preference for problem-solving therapy and/or pharmacotherapy, followed by stepped care; 80 patients) or to usual care (77 patients). At randomization, and then 2, 4, and 6 months later, patients were asked if they (1) missed taking their aspirin; (2) followed a heart healthy diet; (3) exercised regularly; and (4) used tobacco products. Blood pressure was measured before randomization and 6 months later.Results At the end of the intervention, there was no significant improvement in the percentage of intervention compared to control group patients who adhered to aspirin (+3% versus -1%, P = .23), followed a healthy diet (+10% versus +8%, P = .39), exercised regularly (+5% versus +4%, P = .65), abstained from tobacco (-3% versus -1%, P = .77), or had controlled blood pressure (+6% versus +16%, P = .26).Conclusion Despite improving depression, enhanced depression care after an ACS did not improve health behavior or blood pressure control compared to usual care. Research is needed to test whether adding an adherence intervention to enhanced depression care can improve adherence and cardiovascular prognosis in depressed patients post-ACS. (Am Heart J 2012;164:524-9.)