mbct delivered via group videoconferencing for acs syndrome patients with depressive symptoms

Conditions: Acute Coronary Syndrome; Depression; Myocardial Infarction; Unstable Angina; STEMI; NSTEMI - Non-ST Segment Elevation MI

Summary: brief summary: the aim of this study is to explore the initial feasibility and acceptability of (a) mindfulness-based cognitive therapy (mbct) adapted for acs patients; (b) the group videoconferencing delivery medium; and (c) dried blood spot research procedures, to inform refinements for a subsequent pilot rct.

the current study will employ an open pilot trial to determine the initial feasibility and acceptability of a targeted, virtual mbct intervention for acs patients. the investigators plan to enroll approximately n=20 patients (2 cohorts of 10 participants/per cohort, accounting for 20% anticipated lost to follow-up). the mbct intervention will involve 8 virtually-delivered mbct sessions (approximately 1.5 hours each), during which participants will be taught how to use evidence-based mindfulness skills to regulate distress and choose healthy behaviors, as well as learn about cardiac health. participants will be asked to complete a brief survey following each session. within one week before and after the intervention and 3-months post-intervention participants will be asked to complete a series of questionnaires and provide self-collected blood samples. upon completion of the intervention participants will complete an audio-or video recorded exit interview (approximately 30 minutes). participants will be recruited through the the hospital's clinical data registry, advertisements (e.g., flyers, brochures) placed throughout the hospital, direct provider referrals, and from inpatient cardiac units. patients who express interest in the study will be asked complete an eligibility screening. eligible patients agreeable with study participation will then complete a written consent with study staff prior to enrollment. participants will be enrolled in one of two mbct intervention cohorts and expected to participate in 8-weekly, 1.5-hour virtual sessions, in conjunction with approximately 30 minutes of at-home daily practice. a licensed mental health provider (e.g., licsw, phd) trained in the mbct protocol will deliver the intervention. the mbct intervention will be delivered zoom, a secure, hippa-compliant video-conferencing software. study assessments will include a battery of self-report surveys administered at baseline, post-intervention, and 3-month follow-up; session satisfaction surveys administered after each intervention session; post-intervention individual exit interviews (conducted via telephone or videoconference); blood spot samples self-collected by participants at baseline, post-intervention, and 3-month follow-up (submitted to the research team via paper mail); and home practice logs submitted between each intervention session. primary outcomes for the intervention are feasibility and acceptability. data collected from the study will be used to assist in the development of future rcts.

Eligibility criteria:
inclusion criteria: 1. lifetime acs per medical record and/or patient confirmation 2. current elevated depression symptoms (phq-9\>5) 3. age 35-85 years 4. access to high-speed internet exclusion criteria: 1. active suicidal ideation or past-year psychiatric hospitalization (per patient report and/or medical record review) 2. non-english-speaking 3. cognitive impairments preventing informed consent per medical record review and/or cognitive screen \< 4 4. patient deemed unable to complete the study protocol or has a condition that would likely interfere with the study

Keywords: mindfulness acute coronary syndrome videoconferencing depression