Lessons Learned from Study of Depression in Cardiovascular Patients in an Acute-Care Heart and Vascular Hospital

Abstract

Depression is highly prevalent in patients with cardiovascular disease, but questions about the effectiveness of screening and intervention remain unanswered. To evaluate the effects of proactive intervention at an acute-care heart and vascular hospital, patients who reported depressive symptoms on admission were randomized to an active, counseling-based depression intervention plus standard care (referral to a primary or psychiatric care physician) or to standard care alone. Despite early termination of patient enrollment because of lower-than-expected recruitment rates, the project had a positive impact. By involving and educating staff, the investigators raised awareness and improved the process of identifying and helping depressed patients. The lessons in study design and execution gained from this experience will help ensure success in future studies of this condition.

Enhancing physical activity in cardiac patients who report hopelessness: Feasibility testing of an intervention

“…The percentage of patients who reported hopelessness in this IHD sample was similar to that in prior research (Dunn et al, 2017). The percent of patients who reported hopelessness and who were willing to enrol in the study (69.8%) was higher than previous intervention research with hopeless IHD patients (6%) (Davis et al, 2013). This may be attributed to strategies used to increase recruitment and retention, as described earlier.…”

“…The objective of this study was to evaluate the feasibility of conducting a randomised controlled trial investigating the effectiveness of an intervention called Heart Up!, designed to reduce hopelessness through enhanced PA in patients with IHD. Based on prior research with hopeless or depressed IHD patients (Carney et al, 1995;Davis et al, 2013), feasibility was defined as >50% of eligible hopeless patients enrolled and acceptability was defined as >50% of enrolled patients completing the study. Based on a randomised controlled trial examining adherence to depression self-care in patients with chronic illness (McCusker et al, 2016) and a report of 22 behavioural intervention studies (Dzewaltowski et al, 2004), feasibility was also defined as >90% of the intervention components being delivered.…”

“…Because prior research with similar patients has identified low enrollment (6%) and completion (25%) rates (Davis et al, 2013), it was anticipated that patients who report hopelessness might be reluctant to enrol or complete the feasibility study. Therefore, strategies to improve enrollment and retention were developed and implemented.…”

Heart up! RCT protocol to increase physical activity in cardiac patients who report hopelessness: Amended for the COVID‐19 pandemic

“…Given the nature of hopelessness (a negative and helpless outlook), recruiting and retaining patients who report hopelessness can be challenging (Davis et al, 2013). However, attrition rates for the RCT have been lower than expected.…”

Depression and Cardiovascular Disease: Association, Causation, and the Right Thing to Do

“…Davis et al attempted an ambitious study to try to validate a newer screening tool that may be more useful in the evaluation of cardiovascular patients for depression (7). Given the high prevalence of depression and depressive symptoms in this cohort of patients, it would make sense that screening would have a high yield and would allow meaningful intervention from a psychosocial perspective.…”