Collaborative Treatment of Depression and Anxiety Feasible in Hospitalized Cardiac Patients

https://archinte.jamanetwork.com/article.aspx?articleid=1860496MedicalResearch.com Interview with:
Dr. Jeffery  C. Huffman, M.D.
Harvard Medical School
Department of Psychiatry
Massachusetts General Hospital, Boston

MedicalResearch.com: What are the main findings of the study?

Dr. Huffman: Depression and anxiety in cardiac patients are associated with adverse cardiac outcomes.  We completed a very low-intensity care management intervention to identify depression and anxiety disorders during a cardiac admission and then to assist in the monitoring and management of the condition over the next 24 weeks. There have been other care management trials in cardiac patients, but ours was the first to co-manage depression and anxiety, the first to initiate treatment in the hospital, the first to take a broad population of cardiac patients rather than a single diagnosis, and the first to use such a low-resource strategy with only a single part-time social worker to coordinate care.

We found that the care management intervention was associated with significant improvements in mental health treatment, mental health related quality of life, depression, and function at 24 weeks compared to enhanced treatment as usual.  We did not find differences in anxiety, adherence, or cardiac readmissions.


MedicalResearch.com: Were any of the findings unexpected?

Dr. Huffman: It was certainly quite a pleasant surprise to see that such an intervention had significant effects—with moderate effect sizes—on these key clinical outcomes, given the very pragmatic and inclusive approach to enrollment and the low-intensity intervention.   It suggests that this may be the right time to intervene and that a relatively lighter touch—if correctly targeted—may have real effects.

At the same time, this was not a “home run.”   There were not effects on some key outcomes , like anxiety or adherence, and the intervention did not impact readmissions.  So more work needs to be done to get to those important outcomes.

The other unexpected thing is that our “treatment as usual” arm ended up having nearly 50% of patients getting treatment for their condition because we continually informed patients and treaters about the condition and ongoing symptoms in this arm, which is not really treatment as usual—so we ended up giving oursevles a very high bar to get over.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Huffman: That treatment of depression and anxiety disorders in hospitalized cardiac patients is feasible, and when paired with a collaborative care model that facilitates ongoing monitoring and care, can be associated with improvements in key outcomes that are important to patients and physicians.  And it may not take a giant overhaul of existing systems to do so.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Huffman: As I noted, I don’t think this is yet something that is ready for immediate implementation, especially if the goal is cardiac outcomes or readmissions.  I think we have found something that may improve function and quality of life, but to have something that is both more powerful and might impact “bigger” outcomes,  it may be worth having a slightly more intensive intervention post-admission or using a blended care management model in which the case manager monitors both psychiatric and medical symptoms, as in Wayne Katon’s TEAMCare study.

Citation:

Huffman JC, Mastromauro CA, Beach SR, et al. Collaborative Care for Depression and Anxiety Disorders in Patients With Recent Cardiac Events: The Management of Sadness and Anxiety in Cardiology (MOSAIC) Randomized Clinical Trial. JAMA Intern Med. 2014;():. doi:10.1001/jamainternmed.2014.739.