Behavioral Activation Delivered via Home-based Telehealth to Improve Functioning in Cardiovascular Disease Patients Recently Discharged from Inpatient Care

背景和意义： 心血管疾病患者出院后抑郁风险显著增加 (CVD)患者此外，患有抑郁症的心血管疾病患者面临功能下降，发病率增加， 死亡率和生活质量下降。不幸的是，大多数抑郁的心血管疾病患者没有得到 为他们的抑郁症提供适当的循证护理，通常是因为他们无法或害怕旅行 向提供者提供每周8-12次循证心理治疗的方案， 激活（BA）。我们的团队开发，评估并随后在VA诊所实施，第一个VA 计划使用基于家庭的远程医疗提供学士抑郁症的老年退伍军人。我们现建议 评估这种基于证据的治疗和交付模式的能力（通过家庭- 远程医疗），以减少功能障碍，并改善抑郁症退伍军人的恢复， 发生CVD事件相关住院。 研究计划和具体目标： 1.比较行为激活对抑郁症的有效性， 远程医疗-标准CVD后出院最佳实践护理，2x 4（按时间治疗）重复 随机对照试验交叉设计（基线、治疗后、3个月和9个月随访;标准交叉 9个月时的治疗组），其中132名CVD退伍军人患者在中心结局方面表现出抑郁症 功能（PROMIS功能和全球健康量表）和情绪症状（PROMIS抑郁症 和焦虑量表）和与活动相关的次要目标结果（体动记录数据）。在9个月 在这一点上，对照组可以选择接受干预（从而补充RCT 具有交叉相位）。 2.以性别和年龄为自变量重复这些比较。 3.评价BA-HT对探索性结局（包括再次住院）的影响。 假设： 我们预测抑郁症的循证心理治疗（即，行为激活）通过 基于家庭的远程保健将更有效地增加社会角色和活动功能，活动，情绪和 与当前出院后最佳实践相比，减少6个月的再住院（探索性假设） 在PROMIS抑郁量表上评分至少为中度抑郁的患者中进行为期一周的护理 因心血管事件出院后。 影响： 如果有效，这种创新的治疗和交付战略将加强全球功能，改善 提高生活质量，降低退伍军人和退伍军人事务部的成本。重要的是，拟议战略利用现有的 VA基础设施和能力，以便BA-HT可以立即在整个VA提供，作为预防措施 采取措施增强复原力。

Background and Significance: Following hospital discharge, risk of depression is significantly increased in cardio-vascular disease (CVD) patients. Moreover, CVD patients with depression face reduced functioning, increased morbidity and mortality, and diminished quality of life. Unfortunately, most depressed CVD patients do not receive appropriate evidence-based care for their depression, often because they are unable to, or fearful of travelling to providers for the regimen of 8-12 weekly visits of evidence-based psychotherapy such as Behavioral Activation (BA). Our group developed, evaluated and subsequently implemented in VA clinics, the first VA program to use home based telehealth to deliver BA for depression to elderly Veterans. We now propose to evaluate the ability of this evidence based treatment and delivery model (BA for depression via home- telehealth) to reduce functional impairment and improve recovery in depressed Veterans who have experienced a CVD event-related hospitalization. Research Plan and Specific Aims: 1. To compare effectiveness of Behavioral Activation for depression delivered via Home-based Telehealth- to standard post-CVD hospital discharge best-practices care in a 2x4 (treatment by time) repeated measures RCT crossover design (baseline, post-treatment, 3 & 9-month follow-up; crossover for standard treatment group at 9 months) with 132 CVD Veteran patients evincing depression in terms of central outcomes of functioning (PROMIS Functioning and Global Health scales) and emotional symptoms (PROMIS Depression and Anxiety scales) and secondary objective outcomes related to activity (actigraphy data). At the 9 month point, the comparison group will have the option of receiving the intervention (thus complementing the RCT with a crossover phase). 2. To repeat these comparisons with sex and age as independent variables. 3. To evaluate BA-HT with respect to its effects on exploratory outcomes, including re-hospitalization. Hypotheses: We predict that evidence-based psychotherapy for depression (i.e., Behavioral Activation) delivered via home based telehealth will more effectively increase social role and activity functioning, activity, mood and reduce 6-month re-hospitalization (exploratory hypothesis), compared to current best-practices post-discharge care among patients scoring at least moderately depressed on the PROMIS Depression scale one week following hospital discharge for a CVD event. Impact: If effective, this innovative treatment and delivery strategy will enhance global functioning, improve quality of life, and reduce costs to Veterans and the VA. Importantly, the proposed strategy leverages existing VA infrastructure and capabilities so that BA-HT could be immediately offered throughout VA as a preventative measure to enhance resiliency.