ORONARY ARTERY BYPASS graft (CABG) surgery is one of the most common and costly medical procedures performed in the United States. 1 Its main indications are the relief of angina and improvement in quality of life. 2 Yet as many as half of post-CABG patients report depressive symptoms in the perioperative period, 3 are more likely to experience a decreased healthrelated quality of life (HRQL) and functional status, 4 continued chest pains, 5,6 and inreased rates of rehospitalization and death following CABG surgery independent of cardiac status, medical comorbidity, or the extent of surgery. [7][8][9][10][11] Although the mechanism whereby depression affects post-CABG outcomes remains unknown, 12 widely generalizable strategies to detect and effectively treat post-CABG depression are of great interest. Several treatment trials for depression have been conducted in cardiac populations, but most achieved less than anticipated benefits with regard to reducing mood symptoms [13][14][15][16][17][18][19] or cardiovascular morbidity. [13][14][15][16]19,20 Moreover, none used the proven effective collabo-rative care approach 21 recently recommended by a National Institutes of Health expert consensus panel. 22 Unlike earlier interventions that used a single antidepressant, 13,15,17,18 counseling modality, 20 or antidepressant in combination with counseling for treating cardiacpatientswithdepression, 14,19 collabo-rative care emphasizes a flexible realworld treatment package that involves active follow-up by a nonphysician care manager who adheres to evidence-based Author Affiliations are listed at the end of this article.

Objective To present the design of the Bypassing the Blues (BtB) study to examine the impact of a collaborative care strategy for treating depression among patients with cardiac disease. Coronary artery bypass graft (CABG) surgery is one of the most common and costly medical procedures performed in the US. Up to half of post-CABG patients report depressive symptoms, and they are more likely to experience poorer health-related quality of life (HRQoL), worse functional status, continued chest pains, and higher risk of cardiovascular morbidity independent of cardiac status, medical comorbidity, and the extent of bypass surgery. Methods BtB was designed to enroll 450 post-CABG patients from eight Pittsburgh-area hospitals including: (1) 300 patients who expressed mood symptoms preceding discharge and at 2 weeks post hospitalization (Patient Health Questionnaire (PHQ-9) ≥10); and (2) 150 patients who served as nondepressed controls (PHQ-9 <5). Depressed patients were randomized to either an 8-month course of nurse-delivered telephone-based collaborative care supervised by a psychiatrist and primary care expert, or to their physicians’ “usual care.” The primary hypothesis will test whether the intervention can produce an effect size of ≥0.5 improvement in HRQoL at 8 months post CABG, as measured by the SF-36 Mental Component Summary score. Secondary hypotheses will examine the impact of our intervention on mood symptoms, cardiovascular morbidity, employment, health services utilization, and treatment costs. Results Not applicable. Conclusions This effectiveness trial will provide crucial information on the impact of a widely generalizable evidence-based collaborative care strategy for treating depressed patients with cardiac disease.