Bypassing The Blues: Treatment For Depression After Bypass Surgery Improves Quality Of Life And Reduces Cardiac Symptoms

Coronary artery bypass graft (CABG) patients who were screened for depression after surgery and then cared for by a nurse-led team of health care specialists reported better quality of life and improved physical function than those who received their doctors' usual care, according to a study from the University of Pittsburgh School of Medicine. The main outcomes of the study will be presented publicly for the first time at the American Psychosomatic Society's 67th annual meeting in Chicago this week.


CABG surgery is one of the most frequently performed and costly medical procedures performed in the United States. Although the procedure clearly benefits many individuals, depressive symptoms are common following CABG surgery and associated with worse clinical outcomes, including poorer quality of life, continued chest pains and higher risk of re-hospitalization and death.


Bruce L. Rollman, M.D., M.P.H., associate professor of medicine and psychiatry, Center for Research on Health Care, University of Pittsburgh School of Medicine and the study's principal investigator, and Bea Herbeck Belnap, senior research associate, Department of Medicine, University of Pittsburgh School of Medicine, will present early data showing that a collaborative care strategy for CABG is effective in a one-hour symposium at 4:15 p.m., Thursday, March 5 entitled, "The Bypassing the Blues Trial: Telephone-Delivered Collaborative Care for Treating Post-CABG Depression."


Bypassing the Blues is the first trial to examine the impact of a collaborative care strategy, an intervention that included active weekly telephone follow-up by a nurse guided by an evidence-based treatment protocol for depression and who collaborated with the patients' primary care physicians and the study's clinical management team, composed of a psychiatrist, psychologist and internist. This approach has proven effective for treating major depression in primary care settings but had never before been applied to a population with cardiac disease.


"Dozens of studies have described a link between depression and heart disease, and the latest guidelines from the American Heart Association recommend screening all patients with heart disease for depression," said Dr. Rollman. "However, few depression treatment trials have been conducted in patients with cardiac disease, and none used the collaborative care model or examined the impact of treating post-CABG depression on quality of life, re-hospitalizations or health care costs, as we did."


Investigators recruited 453 post-CABG patients at seven Pittsburgh-area hospitals, from 2004 through 2007. They included 302 depressed patients who were randomly assigned to either an eight-month course of telephone-delivered collaborative care or to their doctors' usual care for depression. Investigators also randomly sampled an additional 151 non-depressed, post-CABG patients to facilitate comparisons to depressed patients. They tracked these patients for up to four years to monitor quality of life, physical functioning, mood symptoms, re-hospitalizations, health care costs and deaths. Analysis of the data is ongoing.















Co-authors of the study include Wishwa N. Kapoor, M.D., M.P.H., professor of medicine, Division of General Internal Medicine, and director, Center for Research on Health Care, Charles F. Reynolds III, M.D., department of psychiatry, Western Psychiatric Institute and Clinic, Sati Mazumdar, Ph.D., professor of biostatistics, Graduate School of Public Health, Patty Houck, M.D., statistical services administrator, Graduate School of Public Health, and Peter Counihan, M.D., associate professor of medicine, Cardiovascular Institute, all of the University of Pittsburgh; and Herbert C. Schulberg, Ph.D., psychiatry, Weill Cornell Medical School, and professor emeritus of psychiatry at the University of Pittsburgh.


Dr. Rollman is supported by funding from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.


The University of Pittsburgh School of Medicine is one of the nation's leading medical schools, renowned for its curriculum that emphasizes both the science and humanity of medicine and its remarkable growth in National Institutes of Health (NIH) grant support, which has more than doubled since 1998. For fiscal year 2007, the University ranked sixth out of more than 3,000 entities receiving NIH support with respect to the research grants awarded to its faculty. As one of the university's six Schools of the Health Sciences, the School of Medicine is the academic partner to the University of Pittsburgh Medical Center (UPMC). Their combined mission is to train tomorrow's health care specialists and biomedical scientists, engage in groundbreaking research that will advance understanding of the causes and treatments of disease and participate in the delivery of outstanding patient care.


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