Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial.
Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial.
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DOI：
10.1001/archinternmed.2010.29
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发表时间：
2010-04-12
影响因子：
--
通讯作者：
Burg, Matthew M.
中科院分区：
文献类型：
--
作者：
Davidson, Karina W.;Rieckmann, Nina;Clemow, Lynn;Schwartz, Joseph E.;Shimbo, Daichi;Medina, Vivian;Albanese, Gabrielle;Kronish, Ian;Hegel, Mark;Burg, Matthew M.
抑郁症状是急性冠状动脉综合征（ACS）患者死亡率和主要不良心脏事件（定义为非致死性心肌梗死或因不稳定心绞痛住院或紧急/紧急血运重建）的确定预测因子。本研究旨在确定ACS患者强化抑郁治疗的可接受性和疗效。3个月的观察期以确定ACS和持续抑郁症状的患者，随后进行6个月的随机对照试验。从2005年1月1日到2008年2月29日，来自5家医院的237名ACS患者被纳入研究，其中包括157名持续抑郁症患者，随机分为干预组（最初患者偏好解决问题治疗和/或药物治疗，然后是分步治疗方法；80名患者）或常规治疗组（77名患者），80名接受观察性评估的非抑郁症患者。主要结局是患者对抑郁症治疗的满意度。次要结局是抑郁症状改变（用贝克抑郁量表评估）、主要心脏不良事件和死亡。试验结束时，干预组对抑郁护理满意的患者比例（80人中的54%）高于常规护理组（77人中的19%）（优势比为5.4；95%可信区间[CI]， 2.2 ~ 12.9 [P<.001]）。干预组患者的贝克抑郁量表评分（t155=2.85 [P= 0.005]）（变化，−5.7;95% CI,−7.6至−3.8;df=155）显著高于常规护理组（变化，−1.9;95% CI,−3.8至−0.1;df=155）；抑郁效应量为标准差的0.59。在试验结束时，3名干预组患者和10名常规护理组患者发生了严重的心脏不良事件（分别为4%和13%；log-rank检验，[P= 0.047]）， 5名非抑郁组患者（6%）（干预组与非抑郁组，[P= 0.49]）。加强对ACS患者的抑郁护理与更高的满意度、抑郁症状的更大减少和预后的有希望的改善相关。
Depressive symptoms are an established predictor of mortality and major adverse cardiac events (defined as nonfatal myocardial infarction or hospitalization for unstable angina or urgent/emergency revascularizations) in patients with acute coronary syndrome (ACS). This study was conducted to determine the acceptability and efficacy of enhanced depression treatment in patients with ACS. A 3-month observation period to identify patients with ACS and persistent depressive symptoms was followed by a 6-month randomized controlled trial. From January 1, 2005, through February 29, 2008, 237 patients with ACS from 5 hospitals were enrolled, including 157 persistently depressed patients randomized to intervention (initial patient preference for problem-solving therapy and/or pharmacotherapy, then a stepped-care approach; 80 patients) or usual care (77 patients) and 80 nondepressed patients who underwent observational evaluation. The primary outcome was patient satisfaction with depression care. Secondary outcomes were depressive symptom changes (assessed with the Beck Depression Inventory), major adverse cardiac events, and death. At the end of the trial, the proportion of patients who were satisfied with their depression care was higher in the intervention group (54% of 80) than in the usual care group (19% of 77) (odds ratio, 5.4; 95% confidence interval [CI], 2.2–12.9 [P<.001]). The Beck Depression Inventory score decreased significantly more (t155=2.85 [P=.005]) for intervention patients (change, −5.7; 95% CI, −7.6 to −3.8; df=155) than for usual care patients (change, −1.9; 95% CI, −3.8 to −0.1; df=155); the depression effect size was 0.59 of the standard deviation. At the end of the trial, 3 intervention patients and 10 usual care patients had experienced major adverse cardiac events (4% and 13%, respectively; log-rank test, [P=.047]), as well as 5 nondepressed patients (6%) (for the intervention vs nondepressed cohort, [P=.49]). Enhanced depression care for patients with ACS was associated with greater satisfaction, a greater reduction in depressive symptoms, and a promising improvement in prognosis.
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