Abstract
BackgroundDepression is common in people with coronary heart disease (CHD) and associated with worse outcome. This study explored the acceptability and feasibility of procedures for a trial and for an intervention, including its potential costs, to inform a definitive randomized controlled trial (RCT) of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression.MethodsMulti-centre, outcome assessor-blinded, randomized parallel group study. CHD patients reporting chest pain and scoring 8 or more on the HADS were randomized to personalized care (PC) or treatment as usual (TAU) for 6 months and followed for 1 year. Primary outcome was acceptability and feasibility of procedures; secondary outcomes included mood, chest pain, functional status, well being and psychological process variables.Result1001 people from 17 General Practice CHD registers in South London consented to be contacted; out of 126 who were potentially eligible, 81 (35% female, mean age = 65 SD11 years) were randomized. PC participants (n = 41) identified wide ranging problems to work on with nurse-case managers. Good acceptability and feasibility was indicated by low attrition (9%), high engagement and minimal nurse time used (mean/SD = 78/19 mins assessment, 125/91 mins telephone follow up). Both groups improved on all outcomes. The largest between group difference was in the proportion no longer reporting chest pain (PC 37% vs TAU 18%; mixed effects model OR 2.21 95% CI 0.69, 7.03). Some evidence was seen that self efficacy (mean scale increase of 2.5 vs 0.9) and illness perceptions (mean scale increase of 7.8 vs 2.5) had improved in PC vs TAU participants at 1 year. PC appeared to be more cost effective up to a QALY threshold of approximately £3,000.ConclusionsTrial and intervention procedures appeared to be feasible and acceptable. PC allowed patients to work on unaddressed problems and appears cheaper than TAU.Trial RegistrationControlled-Trials.com ISRCTN21615909
Highlights
The point prevalence of depression in coronary heart disease (CHD) patients has been estimated at 20% in patients with acute myocardial infarction[1] and 9% in a community sample of people with chronic disease[2]
17 practices were approached by the Greater London Primary Care Research Network (PCRN) and agreed to participate
We have developed an intervention for primary care CHD patients with probable depression and current chest pain
Summary
The point prevalence of depression in coronary heart disease (CHD) patients has been estimated at 20% in patients with acute myocardial infarction[1] and 9% in a community sample of people with chronic disease[2]. Collaborative care involves structured management plans, scheduled follow-ups and enhanced inter-professional working, i.e. case manager/practice nurse, primary care practitioner and mental health specialist working together [6], and has been shown to improve indirect cardiac outcomes such as disease control and 10year cardiovascular disease risk as well as depression[6], [7] in people with CHD and/or diabetes. The UPBEAT-UK programme of research[9] was funded by the National Institute for Health Research (NIHR) to explore the relationship between CHD and depression and to develop a new intervention feasible for use in UK primary care. This study explored the acceptability and feasibility of procedures for a trial and for an intervention, including its potential costs, to inform a definitive randomized controlled trial (RCT) of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression
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