A low-intensity intervention aimed at managing cardiac patients who have concomitant depression or anxiety improved mental-health–related quality of life when compared with usual care, according to a report published online April 14 in JAMA Internal Medicine.
The MOSAIC (Management of Sadness and Anxiety in Cardiology) clinical trial involved 183 patients hospitalized at a single urban academic medical center for acute coronary syndrome, heart failure, or arrhythmia during a 2-year period and who were found to have coexisting depression, generalized anxiety disorder, and/or panic disorder. The mean age of the participants was 60.5 years, 90% were white, 61% were employed, 53% were women (JAMA Intern. Med. 2014 April 14 [doi:10.1001/jamainternmend.2014.739]).
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Telephone-based intervention programs may be enough to improve quality-of-life in cardiac patients with depression or anxiety.
They were randomly assigned to receive either usual care or a telephone-based intervention in which a part-time social work care manager coordinated care among psychiatrists, inpatient medical providers, and outpatient medical providers; provided cognitive-behavioral therapy specific to the patient’s condition; and monitored patient symptoms for the 6-month duration of the intervention, said Dr. Jeff C. Huffman, director of cardiac psychiatry research program at Massachusetts General Hospital, and who is in the department of psychiatry at Harvard Medical School, Boston, and his associates.
Patients in the intervention group showed a significantly greater improvement than did those who received usual care in the primary outcome measure: mental-health-related quality of life (QOL), as measured by the Medical Outcomes Study Short Form-12 Mental Component Score. They also were remarkably more likely to receive treatment deemed "adequate" for their psychiatric disorders (75% vs 7%), and to show significantly greater improvement in Patient Health Questionnaire-9 scores; in overall function, as measured on the Duke Activity Status Index; and in health care–related QOL, as measured by EuroQol 5-Domain Instrument scores.
No significant differences were found between the two study groups in cardiac readmission rates at 6 months, but the mean time to readmission was significantly longer for the intervention group (92.4 days) than for the usual care group (62.5 days), Dr. Huffman and his associates said.
The investigators noted that their study involved typical patients seen for cardiac care – including many with serious medical issues and some who declined psychiatric treatment – and so should reflect results that would be found in real-world settings. In addition, using a social worker instead of a nurse as care manager and using telephone rather than in-person contacts substantially saved on costs.
However, Dr. Huffman and his colleagues cited several limitations. For example, the study was conducted in an academic medical center with mostly white patients. Also, those who delivered the intervention had experience with that population and with collaborative care programs.
Still, they expressed optimism about the intervention’s potential. "This intervention seems to have substantial promise as an adjunct or alternative to standard [collaborative care] paradigms," they wrote. "We found that a single care manager was able to coordinate care of three psychiatric conditions in patients with a wide range of cardiac diagnoses living within and outside the metropolitan area of the hospital."
This work was supported in part by the American Heart Association. No relevant financial conflicts of interest were reported.