Acute Coronary Syndromes, Depression
Conditions
Keywords
Health Services Research, Acute Coronary Syndromes, Depression, Integrated care
Brief summary
The overall goal of this study is to develop, pilot test, implement, and evaluate a nurse-coordinated depression care model integrated into the care of Acute Coronary Syndromes (ACS) patients with rigorous assessment of feasibility, effectiveness, acceptability and cost in rural China. This study is a large multi-center, randomized clinical trial among 4,000 ACS patients from 20 rural county hospitals selected from a well-established research network across China.
Interventions
OTHERIntegrated care
an integrated care model for ACS and depression delivered by a collaborative team composed of cardiologists/internists and nurses in the same rural county hospital. The collaborative team will be able to provide medical services for the diagnosis and treatment at acute phase of ACS during hospitalization, ACS secondary prevention therapies at and after discharge, and screening and treatment of depression depressive symptom during hospitalization and after discharge. The core of the interventions includes: depressidepressive symptomon screening and classification, individual counseling and medical treatment of depression, group counseling and health education, and follow-up for ACS and depression treatments compliance, IT- system- assisting theassisted management and necessary referral.
Sponsors
National Institute of Mental Health (NIMH)
Peking University Sixth Hospital
The George Institute for Global Health, China
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 79 Years
Healthy volunteers
No
Inclusion criteria
* Age 20 to 79 years old * Hospitalized due to a diagnosis of Acute Coronary Syndromes (ACS) * ACS is stable (as judged by the treating cardiologist/internist) * Signed patient informed consent
Exclusion criteria
* Affected by severe cardiovascular disease or medical comorbidity that indicate the patient's life expectancy is less than 12 months (e.g. class IV heart failure, terminal cancer) * Seriously disabled (unable to travel to the hospital, class IV heart failure at baseline) * Suffering from problems that affect normal communication (e.g., intellectual impairment, observed mental confusion suggesting dementia, deafness, blindness, etc.) * Non-permanent local residents or permanent residents planning to move out within 12 months * Pregnant or breast-feeding or planning pregnancy within 12 months * Affected by bipolar disorder, schizophrenia or severe depression that meet criteria for referral including patients with acutely suicidal risk (Beck Depression Inventory Item9=3) * Having alcohol dependence (defined by MINI Alcohol Dependence/Abuse Part)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in mean Patient Health Questionnaire-9 (PHQ-9) score from baseline to 6 months | Before patient discharge and after 6 months from discharge | Changes in mean Patient Health Questionnaire-9 (PHQ-9) score from baseline to 6 months |
| Changes in mean PHQ-9 score from baseline to 12 months | Before patient discharge and after 12 months from discharge | Changes in mean Patient Health Questionnaire-9 (PHQ-9) score from baseline to 12 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Major Adverse Cardiovascular Events (MACE) | At least 12 months after discharge | MACE includes all cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and re-hospitalization due to cardiovascular disease. |
| Proportion of patients with self-reported adherence to evidence-based Acute Coronary Syndromes (ACS) secondary prevention treatment at 6 and 12 months | At 6 and 12 months after discharge | ACS secondary prevention treatment means combination use of aspirin, clopidogrel, statin, Angiotensin-Converting Enzyme Inhibitors/ Angiotensin Receptor Blocker and/or beta-blocker. |
| Quality of life (EQ5D) at 6 and 12 months after discharge | At 6 and 12 months after discharge | — |
Other
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Major Adverse Events (MACE) after discharge | At 6 month and 12 month after patients discharged from hospital | Includes all death, non-fatal myocardial infarction, non-fatal stroke, and re-hospitalization for any reasons after discharge |
| Changes in mean Mini-International Neuropsychiatric Interview (MINI) score, Enriched social support instrument(ESSI) score and Perceived social support score (PSSS) score | Before patient discharge and at 6,12 months after discharge | Subsample study. 800 patients from 4 hospitals. |
| Proportion of patients with improved cardiovascular risk surrogates | At 6 month and 12 month after discharge | Improved cardiovascular risk surrogates include blood pressure \< 140/90 mmHg, heart rate \< 70 beats/m, serum Low Density Lipoprotein-cholesterol \< 100 mg/dL and blood sugar \< 7.0 mmol/L |
| Proportion of patients with increased healthy life style | At 6 and 12 months after discharge | Health life style includes physical activity \>= 3 times/wk and more than 30 min. each time; no smoking, no alcohol use, and Body Mass Index (BMI) \< 24 Kg/m2 |
| Proportion of patients with self-reported adherence to general medicine treatment | At 6 and 12 months after discharge | The Morisky scale has been used to measure patients' self-reported adherence |
| The interactions between the intervention effect on the outcomes and the modifiers | At 6 month or 12 month after discharge | Modifiers include severity of depression measured by Patient Health Questionnaire-9(PHQ-9), events within or without 6 months after discharge, age and gender |
Countries
China
Outcome results
None listed