Depression Care for Hospitalized Coronary Heart Disease Patients: Prospective Cohort Study (CDCare)

Depression Care for Hospitalized Coronary Heart Disease Patients: Bridging the Gap Between Guidelines and Reality

The aims of this prospective, observational study are to assess the current use of depression care in Coronary Heart Disease (CHD) patients, and to provide estimates for the resources needed to implement guideline-oriented depression health care acceptable to CHD patients with comorbid depression.

Study Overview

• Status: Completed
• Conditions: Depression; Coronary Heart Disease

Detailed Description

In patients with established CHD, unipolar depression is up to three times more prevalent than in the general population and increases the risk for coronary events and mortality, higher health care consumption and decreased quality of life. Most hospitals in Germany have a unique infrastructure of psychiatric, psychosomatic and psychosocial services for CHD patients (psychiatric/psychosomatic consultation liaison services and a wide network of inpatient or outpatient cardiac rehabilitation centers). However, as of today, little is known about the current use and acceptability of depression health care from the perspective of CHD patients.

This project has two main aims:

1. to assess the current use of depression care in CHD patients who are hospitalized or receive ambulatory care at a cardiology clinic
2. to provide estimates for the resources needed to implement guideline-oriented depression health care acceptable to CHD patients with comorbid depression.

Specifically, the investigators will assess

• rates of and satisfaction with depression health care use in hospitalized CHD patients within one year after hospitalization
• perceived need for depression care and patient preferences for different types, settings and providers of these services
• correlates of depression health care use and patient preferences
• the amount of patients in need for depression health care according to existing recommendations

The secondary objective is to assess direct and indirect costs associated with depressive symptoms and depression care use across 1 year (as indicated by quality of life, event-free survival, productivity, and health care costs).

• Study Type: Observational
• Enrollment (Actual): 1265

Contacts and Locations

Study Locations

• Germany
  • Berlin, Germany, 13353
    • Medizinische Klinik m. Schwerpunkt Kardiologie, Charité Universitätsmedizin

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients with confirmed Coronary Heart Disease (CHD) hospitalized in the coronary care units of 2 University hospitals in Germany. Additionally, starting August 2012, patients with confirmed CHD who receive ambulatory care at one of the cardiology clinics will also be enrolled.

Description

Inclusion Criteria:

• chronic CHD (confirmed by a clinician)

Exclusion Criteria:

• chart-documented dementia disorder
• cognitive impairment
• life expectancy < 1 year
• unavailability for follow-up
• insufficient proficiency in German or Turkish language

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of participants in depression care during the 12 months after hospitalization	Assessed via questionnaire (self-reported psychotherapy for depression and / or antidepressant medication and / or other treatment) at baseline, 1month, 6 month and 12 months Additionally, antidepressant medication prescription will be assessed at baseline via chart review (antidepressant medication at admission and discharge)	Baseline and within one year after hospitalization

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of participants reporting current utilization of mental health care and satisfaction with mental health care	Current mental health care utilization is assessed via questionnaire with a single item ("yes or no"). Satisfaction with current mental health care is assessed via questionnaire with a single continuous rating item (ranging from "very satisfied to not at all satisfied") at baseline and all follow-up assessments (1mo, 6mo and 12months)	Baseline and within one year after hospitalization
Patient preferences for different providers and settings of mental health care services, as indicated by the percentage of patients who indicate actual receipt of or potential willingness to receive mental health care by specific providers and settings	Assessed via questionnaire with at baseline and all follow-up assessments (1mo, 6mo and 12months). A list of mental health care providers (e.g., general practitioner, psychotherapist, psychiatrist, ...) is provided and for each, patients are asked to indicated whether they currently receive mental health care from any provider and if not, if they would be willing to reciev mentral health care by that provider, should they ever be in need (answer options "yes, maybe, no").	Baseline and within one year after hospitalization
Percentage of patients in need for depression health care according to existing recommendations	Baseline: Percentage of patients with a current Major Depressive Episode as assessed via the Composite International Diagnostic Interview (CIDI). 6 months assessment: percentage of patients with a current Major Depressive Episode as assessed via the Composite International Diagnostic Interview (CIDI) - this will only be conducted in a subsample of 300 consecutive participants. Follow-up assessments: percentage of patients with persistently elevated depressive symptoms as indicated by a score of >=10 on the Patient Health Questionnaire (PHQ-9) at baseline and the follow-up assessments.	Baseline and within one year after hospitalization

Collaborators and Investigators

• Sponsor: Charite University, Berlin, Germany
• Collaborators: University Hospital Muenster
• Investigators: Principal Investigator: Jacqueline Müller-Nordhorn, MD, DPH, Charité Universitätsmedizin

Study record dates

Study Major Dates

• Study Start: June 1, 2012
• Primary Completion (Actual): August 1, 2015
• Study Completion (Actual): May 1, 2016

Study Registration Dates

• First Submitted: June 20, 2012
• First Submitted That Met QC Criteria: June 21, 2012
• First Posted (Estimate): June 22, 2012

Study Record Updates

• Last Update Posted (Estimate): August 2, 2016
• Last Update Submitted That Met QC Criteria: August 1, 2016
• Last Verified: August 1, 2016

More Information

Terms related to this study

• Keywords: Depression; Coronary Heart Disease; Health Care Services
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Cardiovascular Diseases; Vascular Diseases; Mood Disorders; Arteriosclerosis; Arterial Occlusive Diseases; Heart Diseases; Depression; Depressive Disorder; Coronary Artery Disease; Myocardial Ischemia; Coronary Disease
• Other Study ID Numbers: 01GY1154

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided