Key result
Collaborative care for depression in adults with CHD reduced short-term MACE (RR 0.54; 95% CI 0.31-0.95; p=0.03), but this reduction was not sustained in the longer term.
Why the study?
Does collaborative care reduce major adverse cardiac events in adults with comorbid depression and coronary heart disease?
Meta-Analysis (n=1,284)
Does collaborative care reduce major adverse cardiac events in adults with comorbid depression and coronary heart disease?
Relative Risk: 0.54 (95% CI 0.31–0.95)
p-value: p=0.03
Collaborative care for depression in patients with coronary heart disease improves mental health symptoms and reduces short-term MACE, though cardiovascular benefits are not sustained long-term.
Short-term MACE reduction supports integrating collaborative care into CHD management; leaves open durability of benefit long-term.
OBJECTIVES: To systematically review the efficacy of collaborative care (CC) for depression in adults with coronary heart disease (CHD) and depression. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Electronic databases (Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, PsycINFO and CINAHL) were searched until April 2014. INCLUSION CRITERIA: Population, depression comorbid with CHD; intervention, randomised controlled trial (RCT) of CC; comparison, either usual care, wait-list control group or no further treatment; and outcome, (primary) major adverse cardiac events (MACE), (secondary) standardised measure of depression, anxiety, quality of life (QOL) and cost-effectiveness. DATA EXTRACTION AND ANALYSIS: RevMan V.5.3 was used to synthesise the data as risk ratios (RRs), ORs and standardised mean differences (SMD) with 95% CIs in random effect models. RESULTS: Six RCTs met the inclusion criteria and comprised 655 participants randomised to CC and 629 participants randomised to the control group (total 1284). Collaborative depression care led to a significant reduction in MACE in the short term (three trials, RR 0.54; 95% CI 0.31 to 0.95, p=0.03) that was not sustained in the longer term. Small reductions in depressive symptoms were evident in the short term (6 trials, pooled SMD -0.31; 95% CI -0.43 to -0.19, p<0.00001) and depression remission was more likely to be achieved with CC (5 trials, OR 1.77; 95% CI 1.28 to 2.44, p=0.0005). Likewise, a significant effect was observed for anxiety symptoms (SMD -0.36) and mental QOL (SMD 0.24). The timing of the intervention was a source of between-group heterogeneity for depression symptoms (between groups p=0.04, I(2)=76.5%). CONCLUSIONS: Collaborative depression care did not lead to a sustained reduction in the primary MACE end point. Small effects were observed for depression, depression remission, anxiety and mental QOL. TRIALS REGISTRATION NUMBER: PROSPERO CRD42014013653.
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Tully et al. (2015) conducted a meta-analysis in coronary heart disease and depression (n=1,284). Collaborative care vs. usual care, wait-list control group or no further treatment was evaluated on major adverse cardiac events (MACE) (RR 0.54, 95% CI 0.31 to 0.95, p=0.03). Collaborative care for depression in adults with CHD reduced short-term MACE (RR 0.54; 95% CI 0.31-0.95; p=0.03), but this reduction was not sustained in the longer term.
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