Bypassing the Blues: Treating depression after heart surgery boosts quality of life, health, Pitt study finds

Bruce L. Rollman

Coronary artery bypass graft (CABG) patients who were screened for depression after surgery and then cared for by a nurse-led team of health care specialists reported better quality of life and improved physical function than those who received their doctors’ usual care, according to a study from the University of Pittsburgh School of Medicine.

The main outcomes of the study were presented at the American Psychosomatic Society’s 67th annual meeting in Chicago earlier this month.

CABG surgery is one of the most frequently performed and costly medical procedures performed in the United States. Although the procedure clearly benefits many individuals, depressive symptoms are common following CABG surgery and associated with worse clinical outcomes, including poorer quality of life, continued chest pains, and higher risk of rehospitalization and death.

Bruce L. Rollman, a professor of medicine and psychiatry, Center for Research on Health Care, University of Pittsburgh School of Medicine and the study’s principal investigator, and Bea Herbeck Belnap, senior research associate, Department of Medicine, Pitt School of Medicine, presented early data showing that a collaborative care strategy for CABG is effective.

The study is the first trial to examine the impact of a collaborative care strategy, an intervention that includes weekly telephone follow-up by a nurse who is guided by a treatment protocol for depression and who collaborates with the patients’ primary care physicians and the study’s clinical management team, comprising a psychiatrist, psychologist, and internist. This approach has proven effective for treating major depression in primary care settings but had never before been applied to a population with cardiac disease.

“Dozens of studies have described a link between depression and heart disease, and the latest guidelines from the American Heart Association recommend screening all patients with heart disease for depression,” said Rollman. “However, few depression treatment trials have been conducted in patients with cardiac disease, and none used the collaborative care model or examined the impact of treating post-CABG depression on quality of life, rehospitalizations, or health care costs, as we did.”

Investigators recruited 453 post-CABG patients at seven Pittsburgh-area hospitals from 2004 through 2007. They included 302 depressed patients who were randomly assigned to either an eight-month course of telephone-delivered collaborative care or to their doctors’ usual care for depression. Investigators also randomly sampled an additional 151 nondepressed, post-CABG patients to facilitate comparisons to depressed patients. They tracked these patients for a maximum of four years to monitor quality of life, physical functioning, mood symptoms, rehospitalizations, health care costs, and deaths. Analysis of the data is ongoing.

Pitt coauthors of the study include Wishwa N. Kapoor, Falk Professor of Medicine
and chief, Division of General Internal Medicine, School of Medicine; Charles F. Reynolds, UPMC Professor of Geriatric Psychiatry and professor of neurology and neuroscience, School of Medicine; Sati Mazumdar, professor of biostatistics, Graduate School of Public Health; Patty Houck, statistical services administrator, Graduate School of Public Health; and Peter Counihan, professor of medicine, Cardiovascular Institute, School of Medicine. Herbert C. Schulberg, a clinical professor of psychology in psychiatry, Weill Cornell Medical School, and professor emeritus of psychiatry at Pitt, was also a coauthor.

Rollman is supported by funding from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.