Long-term efficacy of a tele-health intervention for acute coronary syndrome patients with depression: 12-month results of the MoodCare randomized controlled trial
Long-term efficacy of a tele-health intervention for acute coronary syndrome patients with depression: 12-month results of the MoodCare randomized controlled trial
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DOI：
10.1177/2047487314547655
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发表时间：
2015-09-01
影响因子：
8.3
通讯作者：
Oldenburg, Brian
中科院分区：
文献类型：
--
作者：
O'Neil, Adrienne;Taylor, Barr;Oldenburg, Brian
背景：心脏事件后抑郁很常见；然而，它经常得不到治疗。此前，我们报告了为期6个月的远程健康计划(MoodCare)的有效性和可行性，该计划将抑郁管理整合到针对情绪低落的急性冠脉综合征(ACS)患者的心血管疾病(CVD)风险降低计划中。在这里，我们在12个月的随访中评估该计划的长期疗效。设计：一项双臂平行随机设计，比较12个月时‘MoodCare’(n=61)和常规护理(UC)(n=60)的长期效果。方法：从澳大利亚维多利亚和布里斯班的六家医院招募的121名急性冠脉综合征患者被随机分为电话传递的认知行为治疗和降低风险计划或常规医疗。结果：12个月后，重度抑郁障碍患者对PHQ-9抑郁症的治疗效果显著(情绪护理：平均分：6.5分；95%可信区间：4.9-8.0对UC：9.3分；95%可信区间：7.7-10.9分，p=0.012)。95%CI：39.8-45.2vs UC：36.8；95%CI：34.1-39.6，p=0.005)。在基线上没有MDD的患者中没有观察到有益的治疗效果。结论：12个月后，对于临床诊断为重度抑郁症的患者，MoodCare在改善心理健康结果方面优于UC。我们的发现支持对临床诊断为抑郁症的心脏病患者实施基于抑郁的干预措施，并提供了一年内长期疗效的证据。
Background: Depression is common after a cardiac event; however it often remains untreated. Previously, we reported the efficacy and feasibility of a 6-month tele-health programme (MoodCare), which integrates depression management into a cardiovascular disease (CVD) risk reduction programme for Acute Coronary Syndrome (ACS) patients with low mood. Here, we evaluate the long-term efficacy of the programme at 12-month follow-up.Design: A two-arm, parallel, randomized design to compare the long-term effects of 'MoodCare' (n=61) to usual care (UC) (n=60) at 12 months.Method: 121 ACS patients recruited from six hospitals in Victoria and Brisbane, Australia were randomized to a telephone-delivered cognitive behavioural therapy and risk-reduction programme or usual medical care. Mixed-model repeated measurements (MMRM) analysis was applied with results expressed as estimated marginal mean changes in depression and health-related quality of life (HRQOL) outcomes by group.Results: After 12 months, treatment effects were observed for those with major depressive disorder (MDD) for PHQ-9 depression (MoodCare: mean score: 6.5; 95% CI: 4.9-8.0 versus UC: 9.3; 95% CI: 7.7-10.9, p=0.012)) and SF-12 mental health scores (MoodCare: 42.5; 95% CI: 39.8-45.2 versus UC: 36.8; 95% CI: 34.1-39.6, p=0.005). No beneficial treatment effects were observed in those with no MDD at baseline.Conclusion: After 12 months, MoodCare was superior to UC for improving mental health outcomes for those with a clinical diagnosis of major depression. Our findings support the implementation of depression-based interventions for cardiac patients with a clinical diagnosis of depression and provide evidence of longer term efficacy to one year.