Impact of a Depression Care Management Program for Hospitalized Cardiac Patients
Impact of a Depression Care Management Program for Hospitalized Cardiac Patients
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DOI：
10.1161/circoutcomes.110.959379
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发表时间：
2011-03-01
影响因子：
6.9
通讯作者：
Januzzi, James L.
中科院分区：
文献类型：
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作者：
Huffman, Jeff C.;Mastromauro, Carol A.;Januzzi, James L.
背景-在急性心脏病患者中，抑郁与不良预后独立相关。协作性护理抑郁管理计划已被用于门诊患者以改善抑郁结果，但这样的计划从未在医院启动或用于患有广泛心脏疾病的患者。方法和结果-这是一项前瞻性随机试验，对175名因急性冠脉综合征、心律失常或心力衰竭住院的抑郁症患者进行低强度、12周的协作性护理计划和常规护理。使用混合回归模型评估6周、12周和6个月组的研究结果，包括精神健康(抑郁、抑郁认知症状、焦虑和与精神健康相关的生活质量)和医疗结果(与身体健康相关的生活质量、遵守医疗建议和心脏症状)。协作性护理受试者(n=90)在6周和12周时对所有心理健康结果有显著改善，包括抑郁反应率(协作性护理，59.7%对常规护理33.7%；优势比，2.91；6周时P=0.003；51.5%对34.4%；优势比，2.02；12周时P=0.04)，但这些影响在干预后降低。在6个月时，干预对象的自我报告依从性显著提高，心脏症状的数量和强度显著减少。结论-在有广泛心脏诊断的患者中，住院期间启动的协作式护理抑郁管理计划显著改善了多种临床重要心理健康结果，并在干预后对相关医疗结果产生了良好的效果。
Background-Depression is independently associated with poor outcomes among patients with acute cardiac disease. Collaborative care depression management programs have been used in outpatients to improve depression outcomes, but such a program had never been initiated in the hospital or used for patients with a wide range of cardiac illnesses.Methods and Results-This was a prospective, randomized trial of a low-intensity, 12-week collaborative care program versus usual care for 175 depressed patients hospitalized for acute coronary syndrome, arrhythmia, or heart failure. Study outcomes, assessed using mixed regression models to compare groups at 6 weeks, 12 weeks, and 6 months, included mental health (depression, cognitive symptoms of depression, anxiety, and mental health-related quality of life) and medical (physical health-related quality of life, adherence to medical recommendations, and cardiac symptoms) outcomes. Collaborative care subjects (n = 90) had significantly greater improvements on all mental health outcomes at 6 and 12 weeks, including rates of depression response (collaborative care, 59.7% versus usual care 33.7%; odds ratio, 2.91; P = 0.003 at 6 weeks; 51.5% versus 34.4%; odds ratio, 2.02; P = 0.04 at 12 weeks), though these effects decreased after intervention. At 6 months, intervention subjects had significantly greater self-reported adherence and significantly reduced number and intensity of cardiac symptoms.Conclusions-Among patients with a broad range of cardiac diagnoses, a collaborative care depression management program initiated during hospitalization led to significant improvements in multiple clinically important mental health outcomes and had promising effects on relevant medical outcomes after intervention.