(Press-News.org) A clinical trial of patients with post-acute coronary syndrome (ACS, heart disease) depression finds that a centralized, patient-preference program decreased depressive symptoms and may be cost-neutral over time, according to a report published Online First by JAMA Internal Medicine, a JAMA Network publication. The study is being released early to coincide with its presentation at the American College of Cardiology's annual Scientific Sessions.
About 1.2 million Americans survive an ACS event every year and many of them have clinically significant and persistent depression. Post-ACS depression is also associated with an increased risk of ACS recurrence and with an increase in the relative risk of all-cause mortality, the authors write in the study background.
Karina W. Davidson, Ph.D., of the Columbia University College of Physicians & Surgeons, New York, and colleagues sought to determine the effects of providing post-ACS depression care on symptoms and health care costs in a multicenter randomized controlled trial.
A total of 150 patients were divided into two groups for six months of treatment. Of the patients, 73 were enrolled in the intervention group in which they could receive centralized depression care that was based on patient preference for problem-solving treatment given by telephone or the Internet, medication, both or neither. The other 77 patients were enrolled in the usual care group in which they were free to obtain depression from their primary care physician, cardiologist or any other health care practitioner, according to the study.
"For patients with post-ACS depression, active treatment had a substantial beneficial effect on depressive symptoms. This kind of depression care is feasible, effective and may be cost-neutral within six months; therefore, it should be tested in a large phase 3 pragmatic trial," the study notes.
According to study results, depressive symptoms decreased significantly more in the active treatment group than in the usual care group (differential change between groups, -3.51 BDI [Beck Depression Inventory] points. Mental health costs were higher for the active treatment group than for the usual care group (adjusted change, $687), while average hospital costs were lower in the intervention group (adjusted change, -$1010). As a result of the offset, overall health care estimated costs in the study intervention group were not statistically different than in the comparison group (adjusted change, -$325), according to the results.
"A large phase 3 trial would inform evidence-based depression treatment guidelines for patients with an ACS, and even has the tantalizing possibility of answering the important question of whether treating depression in patients with ACS lowers mortality and recurrence rates," the study concludes.
(JAMA Intern Med. Published online March 7, 2013. doi:10.1001/jamainternmed.2013.915. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: An author made a conflict of interest disclosure. The work was supported by grants from the National Institutes of Health (NIH), Bethesda, Md., and was supported in part by Columbia University's CTSA from the National Center for Advancing Translational Sciences/NIH. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Benefits, Costs of Improving Depression Treatment for Patients With Heart Disease
In a related commentary, Gregory E. Simon, M.D., M.P.H., Group Health Cooperative, Seattle, writes: "In this issue of JAMA Internal Medicine, Davidson et al describe the benefits of an organized depression care program for outpatients experiencing significant symptoms of depression after acute coronary syndrome (ACS)."
"While the CODIACS [Comparison of Depression Interventions after Acute Coronary Syndrome] investigators conclude that the depression care program was 'cost neutral,' I would be more cautious in interpreting the finding of no significant difference in cost," Simon wrote.
"Instead of concluding that this depression care program is cost neutral, I would conclude that this sample is far too small to accurately estimate the effect of the program on use or cost of general medical services _ especially the highly variable category of inpatient medical costs," the study concludes.
(JAMA Intern Med. Published online March 7, 2013. doi:10.1001/jamainternmed.2013.925. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
### END
Patients with post-ACS depression benefitted from active treatment in clinical trial
2013-03-08
ELSE PRESS RELEASES FROM THIS DATE:
Farmers who commit totally to sell locally can make a profit
2013-03-08
UNIVERSITY PARK, Pa. -- Farmers can make a profit selling their produce directly to local businesses, but they must not let possible new costs weaken their commitment to the new venture, according to an international team of researchers.
"We found that the farmers who really made a conscious decision to sell local and who made more of a commitment tended to do better than those who are just testing the waters with local direct selling," said Amit Sharma, associate professor of hospitality management, Penn State.
Sharma added that farmers who were only testing the idea ...
Partner abuse counseling for women insufficient
2013-03-08
HERSHEY, Pa. -- Only about one in five central Pennsylvania women who have experienced intimate partner violence is asked or counseled by a health care provider about abuse, according to Penn State medicine and public health science researchers. Overall, approximately only one in nine women has received preventive counseling about violence and safety.
"Our research shows that we (as a healthcare community) haven't been doing a good job of identifying and counseling about intimate partner violence," said Jennifer S. McCall-Hosenfeld, primary care physician and assistant ...
NIH study sheds light on role of climate in influenza transmission
2013-03-08
Two types of environmental conditions—cold-dry and humid-rainy—are associated with seasonal influenza epidemics, according to an epidemiological study led by researchers at the National Institutes of Health's Fogarty International Center. The paper, published in PLOS Pathogens, presents a simple climate-based model that maps influenza activity globally and accounts for the diverse range of seasonal patterns observed across temperate, subtropical and tropical regions.
The findings could be used to improve existing current influenza transmission models, and could help ...
Pushing the boundaries
2013-03-08
Researchers at Johns Hopkins have established a high-efficiency cell-cell fusion system, providing a new model to study how fusion works. The scientists showed that fusion between two cells is not equal and mutual as some assumed, but, rather, is initiated and driven by one of the fusion partners. The discovery, they say, could lead to improved treatments for muscular dystrophy, since muscle regeneration relies on cell fusion to make muscle fibers that contain hundreds or even thousands of nuclei.
The study reveals two critical components that have to be present for cell ...
German women are more physically active than their European counterparts yet remain indifferent to sport
2013-03-08
This press release is available in German.
Geneva, Switzerland (07 March, 2013) – A new survey reveals that 44 per cent of German women did not play competitive sport or spend any time on intensive workouts such as running or cycling, in a given week. German women remain reluctant to devote any time to competitive sport, despite being more physically active than their European counterparts in Britain, Denmark, Sweden and France, according to a new multi-national survey on sport and exercise habits. With Germany favourites to be crowned champions at this summer's UEFA ...
As Brazil ramps up sugarcane production researchers foresee regional climate effects
2013-03-08
TEMPE, Ariz. – Conversion of large swaths of Brazilian land for sugar plantations will help the country meet its needs for producing cane-derived ethanol but it also could lead to important regional climate effects, according to a team of researchers from Arizona State University, Stanford University and the Carnegie Institution for Science.
The team found that anticipated conversion to sugarcane plantations could lead to a 1°C decrease in temperature during the growing season, to be followed by a 1°C increase after harvest.
"When averaged over the entire year, there ...
Glaciers will melt faster than ever and loss could be irreversible warn scientists
2013-03-08
Canada's Arctic Archipelago glaciers will melt faster than ever in the next few centuries. Research by European funded scientists has shown that 20 per cent of the Canadian Arctic glaciers may have disappeared by the end of this century which would amount to an additional sea level rise of 3.5cm
The results of the research, part of the EU funded ice2sea programme, will be published in Geophysical Research Letters this week, and the paper is now available online.
The researchers developed a climate model for the island group of the north of Canada in which they simulated ...
Illuminating fractures: X-ray imaging sheds new light on bone damage
2013-03-08
ITHACA, N.Y. — From athletes to individuals suffering from osteoporosis, bone fractures are usually the result of tiny cracks accumulating over time -- invisible rivulets of damage that, when coalesced, lead to that painful break.
Using cutting-edge X-ray techniques, Cornell University researchers have uncovered cellular-level detail of what happens when bone bears repetitive stress over time, visualizing damage at smaller scales than previously observed. Their work could offer clues into how bone fractures could be prevented.
Marjolein van der Meulen, professor of ...
IRB Barcelona researchers discover mechanism that regulates steroid hormone production in Drosophila
2013-03-08
Looking at the transformation of a fly larva into a pupa may help researchers to understand the molecular mechanisms that trigger puberty. A study conducted on the fruit fly, Drosophila melanogaster, by scientists at the Institute for Research in Biomedicine (IRB Barcelona) led by ICREA research professor Marco Milán, identifies an miRNA as key to the relationship between hormones that control growth and sexual maturity. According to Milán, "accelerated growth or obesity can provoke premature puberty in humans, harming their development – and this is a growing problem in ...
Money talks when it comes to losing weight, Mayo Clinic study finds
2013-03-08
SAN FRANCISCO -- Weight loss study participants who received financial incentives were more likely to stick with a weight loss program and lost more weight than study participants who received no incentives, according to Mayo Clinic research that will be presented Saturday, March 9 at the American College of Cardiology's 62nd Annual Scientific Session.
Previous studies have shown that financial incentives help people lose weight, but this study examined a larger group of participants (100) over a longer period (one year), says lead author Steven Driver, M.D., an internal ...