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Collaborative care for comorbid depression and coronary heart disease: a systematic review and meta-analysis of
Phillip J Tully1, Harald Baumeister2
1Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia INSERM, U897-Epidemiology and Biostatistics, Bordeaux, France.
Insights
Collaborative care for depression in adults with coronary heart disease significantly reduced major adverse cardiac events short-term, but effects on depression, anxiety, and quality of life were small and not sustained.
Area of Science:
- Cardiology
- Psychiatry
- Health Services Research
Background:
- Comorbid depression in adults with coronary heart disease (CHD) poses significant health challenges.
- Collaborative care (CC) is a model designed to improve management of chronic conditions.
- The efficacy of CC for depression in CHD patients requires systematic evaluation.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness of collaborative care (CC) for depression in adults with coronary heart disease (CHD).
- To assess the impact of CC on major adverse cardiac events (MACE), depression, anxiety, quality of life (QOL), and cost-effectiveness.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched multiple electronic databases up to April 2014.
- Included RCTs comparing CC to usual care, wait-list, or no treatment in adults with CHD and depression.
Main Results:
- Six RCTs (1284 participants) were included.
- CC significantly reduced short-term MACE (RR 0.54; 95% CI 0.31-0.95) but not long-term.
- Small, significant improvements were noted for depression symptoms (SMD -0.31), depression remission (OR 1.77), anxiety (SMD -0.36), and mental QOL (SMD 0.24).
Conclusions:
- Collaborative care for depression in CHD patients shows short-term benefits for MACE, but these are not sustained.
- CC yields small but significant improvements in depression, anxiety, and mental quality of life.
- Intervention timing may influence depression symptom outcomes, indicating a need for further research.
Objectives:
To systematically review the efficacy of collaborative care (CC) for depression in adults with coronary heart disease (CHD) and depression.
Design:
Systematic review and meta-analysis.
Data Sources:
Electronic databases (Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, PsycINFO and CINAHL) were searched until April 2014.
Inclusion Criteria:
Population, depression comorbid with CHD; intervention, randomised controlled trial (RCT) of CC; comparison, either usual care, wait-list control group or no further treatment; and outcome, (primary) major adverse cardiac events (MACE), (secondary) standardised measure of depression, anxiety, quality of life (QOL) and cost-effectiveness.
Data Extraction And Analysis:
RevMan V.5.3 was used to synthesise the data as risk ratios (RRs), ORs and standardised mean differences (SMD) with 95% CIs in random effect models.
Results:
Six RCTs met the inclusion criteria and comprised 655 participants randomised to CC and 629 participants randomised to the control group (total 1284). Collaborative depression care led to a significant reduction in MACE in the short term (three trials, RR 0.54; 95% CI 0.31 to 0.95, p=0.03) that was not sustained in the longer term. Small reductions in depressive symptoms were evident in the short term (6 trials, pooled SMD -0.31; 95% CI -0.43 to -0.19, p<0.00001) and depression remission was more likely to be achieved with CC (5 trials, OR 1.77; 95% CI 1.28 to 2.44, p=0.0005). Likewise, a significant effect was observed for anxiety symptoms (SMD -0.36) and mental QOL (SMD 0.24). The timing of the intervention was a source of between-group heterogeneity for depression symptoms (between groups p=0.04, I(2)=76.5%).
Conclusions:
Collaborative depression care did not lead to a sustained reduction in the primary MACE end point. Small effects were observed for depression, depression remission, anxiety and mental QOL.
Trials Registration Number:
PROSPERO CRD42014013653.