Conclusions We found that psychological intervention  improved psychological symptoms and reduced cardiac mortality for people with CHD .
However , there remains considerable uncertainty regarding the magnitude of these effects and the specific techniques most likely to benefit people with different presentations of CHD
Background Although psychological interventions are recommended for the management of coronary heart disease ( CHD ) , there remains considerable uncertainty regarding their effectiveness .
Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial.
BACKGROUND Depressive symptoms are an established predictor of mortality and major adverse cardiac events ( defined as nonfatal myocardial infa rct ion or hospitalization for unstable angina or urgent/emergency revascularizations ) in patients with acute coronary syndrome ( ACS ) . This study was conducted to determine the acceptability and efficacy of enhanced depression treatment in patients with ACS . METHODS A 3-month observation period to identify patients with ACS and persistent depressive symptoms was followed by a 6-month r and omized controlled trial . From January 1 , 2005 , through February 29 , 2008 , 237 patients with ACS from 5 hospitals were enrolled , including 157 persistently depressed patients r and omized to intervention  ( initial patient preference for problem-solving therapy and /or pharmacotherapy , then a stepped-care approach ; 80 patients ) or usual care ( 77 patients ) and 80 nondepressed patients who underwent observational evaluation . The primary outcome was patient satisfaction with depression care . Secondary outcomes were depressive symptom changes ( assessed with the Beck Depression Inventory ) , major adverse cardiac events , and death . RESULTS At the end of the trial , the proportion of patients who were satisfied with their depression care was higher in the intervention group ( 54 % of 80 ) than in the usual care group ( 19 % of 77 ) ( odds ratio , 5.4 ; 95 % confidence interval [ CI ] , 2.2 - 12.9 [ P < .001 ] ) . The Beck Depression Inventory score decreased significantly more ( t(155 ) = 2.85 [ P = .005 ] ) for intervention patients ( change , -5.7 ; 95 % CI , -7.6 to -3.8 ; df = 155 ) than for usual care patients ( change , -1.9 ; 95 % CI , -3.8 to -0.1 ; df = 155 ) ; the depression effect size was 0.59 of the st and ard deviation . At the end of the trial , 3 intervention patients and 10 usual care patients had experienced major adverse cardiac events ( 4 % and 13 % , respectively ; log-rank test , chi(2)(1 ) = 3.93 [ P = .047 ] ) , as well as 5 nondepressed patients ( 6 % ) ( for the intervention vs nondepressed cohort , chi(2)(1 ) = 0.48 [ P = .49 ] ) . CONCLUSION Enhanced depression care for patients with ACS was associated with greater satisfaction , a greater reduction in depressive symptoms , and a promising improvement in prognosis . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00158054
Conclusions We found that psychological intervention  improved psychological symptoms and reduced cardiac mortality for people with CHD .
However , there remains considerable uncertainty regarding the magnitude of these effects and the specific techniques most likely to benefit people with different presentations of CHD
Background Although psychological interventions are recommended for the management of coronary heart disease ( CHD ) , there remains considerable uncertainty regarding their effectiveness .