Cognitive Behavioral Therapy in Depressed Cardiac Surgery Patients

Q: What are the key findings of this study?

Nurse-guided CBT significantly reduced depressive symptoms over 8 weeks after cardiac surgery compared to usual care, improving BDI scores by 75.3% in low EF (<40%) and 31.0% in preserved EF (p=0.019).

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Depression after cardiac surgery (CABG or valve replacement/repair) stratified by ejection fraction (n=77). Intervention: Nurse-guided cognitive behavioral therapy (CBT) vs. Usual care (referrals to primary care/mental health services plus biweekly follow-up phone calls). Primary outcome: Change in Beck Depression Inventory (BDI) scores over 8 weeks by treatment group and ejection fraction status (three-way interaction of time, treatment, and EF) (F(1, 71) = 5.78, p=0.019).

Q: What does this research mean for the field?

Nurse-guided cognitive behavioral therapy significantly reduces depressive symptoms after cardiac surgery, with greater symptom reduction observed in patients with low ejection fraction compared to preserved ejection fraction. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the relationship between ejection fraction status and depressive symptoms in cardiac surgery patients assigned to nurse-guided cognitive behavioral therapy versus usual care.

Boyoung Hwang; Jo‐Ann Eastwood; Anthony McGuire; Belinda Chen; Rebecca Cross-Bodán; Lynn V. Doering

doi:10.1097/jcn.0000000000000155

April 24, 2014The Journal of Cardiovascular Nursing

Cognitive Behavioral Therapy in Depressed Cardiac Surgery Patients

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Key result

Nurse-guided CBT reduces post-cardiac surgery depression symptoms, cutting BDI scores ~75% in low EF.

F(1, 71) = 5.78
P=0.019
n=77

Why the study?

Does nurse-guided cognitive behavioral therapy improve depressive symptoms differently in post-cardiac surgery patients with low ejection fraction (<40%) compared to those with preserved ejection fraction (≥40%)?

Key Points

To evaluate the relationship between ejection fraction status and depressive symptoms in cardiac surgery patients assigned to nurse-guided cognitive behavioral therapy versus usual care.
Evaluated 77 cardiac surgery patients (31% women; mean [SD] age, 63.6 [9.8] years) assigned to 8 weeks of nurse-guided cognitive behavioral therapy (CBT) or usual care (UC).
Assessed depressive symptoms at baseline and after 8 weeks using the Beck Depression Inventory (BDI).
Analyzed symptom changes across ejection fraction categories (preserved EF ≥40% vs low EF <40%) using repeated-measures analysis of variance while controlling for Charlson Comorbidity Index scores.
There was a significant three-way interaction among time, treatment group, and ejection fraction status (F(1, 71) = 5.78, p = 0.019).
In patients with preserved ejection fraction (≥40%), mean BDI scores worsened by 1.9% (p = .88) with usual care and improved by 31.0% (p = .006) with cognitive behavioral therapy.
In patients with low ejection fraction (<40%), mean BDI scores worsened by 26.8% (p = .23) with usual care and improved by 75.3% (p = .001) with cognitive behavioral therapy.

Study Design

Type

RCT (n=77)

Blinding

Single-blind (outcome assessor blinded to treatment group)

Randomization

Randomized to receive either 8 weeks of nurse-guided CBT or UC

Multicenter

Yes

Structured PICO

Does nurse-guided cognitive behavioral therapy improve depressive symptoms differently in post-cardiac surgery patients with low ejection fraction (<40%) compared to those with preserved ejection fraction (≥40%)?

P

Population

77 depressed adults recovering from cardiac surgery (mean age 63.6 years, 31% women; 17% with LVEF <40% and 83% with LVEF ≥40%), followed for 8 weeks.

I

Intervention

Home-based nurse-guided cognitive behavioral therapy (CBT) conducted by advanced practice nurses, consisting of 8 weekly one-on-one in-person sessions lasting 50 to 60 minutes each over 8 weeks.

C

Comparator

Usual care (UC), consisting of referrals to primary care providers and mental health services plus short biweekly follow-up phone calls from study staff over an 8-week period to maintain contact.

O

Outcome

Change in depressive symptoms over 8 weeks evaluated by the 21-item self-report Beck Depression Inventory (BDI) total score, assessing the interaction among time, treatment group, and EF status (<40% vs ≥40%).patient reported

Main Result

Effect estimate: F(1, 71) = 5.78

Absolute Event Rate: -75.3% vs 26.8%

p-value: p=0.019

Home-based, nurse-guided cognitive behavioral therapy significantly reduces postoperative depression after cardiac surgery, with the greatest symptom reduction observed in high-risk patients with left ventricular ejection fraction <40%.

Limitations

Small sample size limiting generalizability, particularly the small number of patients with low EF (n=13)
Short follow-up duration of 8 weeks, leaving long-term effects unknown
Lack of assessment of additional clinical outcomes such as physical functioning and mortality
Secondary analysis of an existing clinical trial
Small sample size limiting generalizability, particularly the small subgroup of patients with low EF (n=13)
Short 8-week follow-up period, precluding evaluation of long-term effects on depressive symptoms
Did not assess downstream clinical outcomes such as physical functioning or mortality
Secondary analysis of data from a clinical trial

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Implication

Nurse-guided CBT merits consideration in post-cardiac surgery depression care, especially for low EF; extends CBT evidence to EF-stratified cardiac populations.

Abstract

AIMS: The aim of this study was to evaluate the relationship of ejection fraction (EF) and depressive symptoms in cardiac surgery patients assigned to nurse-guided cognitive behavioral therapy (CBT) or usual care (UC). METHODS: Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Seventy-seven patients (31% women; mean [SD] age, 63.6 [9.8] years) received 8 weeks of either CBT or UC. Using repeated-measures analysis of variance, changes in depressive symptoms over time were evaluated. RESULTS: There was a significant interaction among time, treatment group, and EF status (p = 0.019). In the patients with preserved EF (≥40%), mean BDI scores in the UC group worsened by 1.9%, whereas those in the CBT group improved by 31.0%. In the patients with low EF (<40%), mean BDI scores worsened by 26.8% and improved by 75.3% in the UC and CBT groups, respectively. CONCLUSIONS: Nurse-guided CBT is effective in reducing depressive symptoms after cardiac surgery, particularly in patients with low EF.

Discussion

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Cite This Study

Hwang et al. (2014) conducted an RCT in Depression after cardiac surgery (CABG or valve replacement/repair) stratified by ejection fraction (n=77). Nurse-guided cognitive behavioral therapy (CBT) vs. Usual care (referrals to primary care/mental health services plus biweekly follow-up phone calls) was evaluated on Change in Beck Depression Inventory (BDI) scores over 8 weeks by treatment group and ejection fraction status (three-way interaction of time, treatment, and EF) (F(1, 71) = 5.78, p=0.019). Nurse-guided CBT significantly reduced depressive symptoms over 8 weeks after cardiac surgery compared to usual care, improving BDI scores by 75.3% in low EF (<40%) and 31.0% in preserved EF (p=0.019).

synapsesocial.com/papers/6a78f568fc98817f16020a4c https://doi.org/10.1097/jcn.0000000000000155

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Cognitive Behavioral Therapy in Depressed Cardiac Surgery Patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Cognitive Behavioral Therapy in Depressed Cardiac Surgery Patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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