The Bypassing the Blues Treatment Protocol: Stepped Collaborative Care for Treating Post-CABG Depression

Abstract

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.

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…Men were more likely to benefit from the intervention. 668,669 In another study, 123 patients who met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for major or minor depression within 1 year of CABG were randomly assigned to 12 weeks of cognitive behavior therapy, 12 weeks of supportive stress management, or usual care. 667 Both interventions were efficacious for treating depression after CABG, and cognitive behavior therapy had the most durable effects on depression and several secondary psychological outcome variables.…”

Optimism, Response to Treatment of Depression, and Rehospitalization After Coronary Artery Bypass Graft Surgery

“…The research design for the Bypassing the Blues Study has been detailed previously (23,24) and was approved by the institutional review board at the University of Pittsburgh and each participating hospital.…”

“…We examined these issues in a secondary analysis of data from the Bypassing the Blues study (23,24), the first randomized controlled trial (RCT) designed to examine the impact of telephone-delivered collaborative care for treating post-CABG depression on HRQoL, physical functioning, and mood (23). We hypothesized that depressed individuals reporting high optimism (versus those with high pessimism) would demonstrate: a) more favorable baseline profiles of sociodemographic, clinical, psychiatric, and HRQoL variables; b) higher rates of response to treatment of depression after CABG; and c) lower rates of rehospitalization after CABG independent of their depressive moods.…”

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…At 8 month follow-up, the collaborative care group showed an improvement in quality of life and physical functioning and were more likely to report a Ͼ50% decline in the Hamilton Rating Score for Depression than the usual care group (50.0% versus 29.6%; pϽ0.001). Men were more likely to benefit from the intervention (668,669). In another study, 123 patients who met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for major or minor depression within 1 year of CABG were randomly assigned to 12 weeks of cognitive behavior therapy, 12 weeks of supportive stress management, or usual care (667).…”