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Am Fam Physician. 2010;82(7):828

Background: Persons with acute coronary syndrome (ACS) and depressive symptoms are at higher risk of further coronary events. Few studies of this population have been done, which has impaired the ability to detect whether treatment of depression may improve outcomes in this population. Davidson and colleagues attempted to determine if the Coronary Psychosocial Evaluation Studies (COPES) intervention improved patient satisfaction with depression care.

The Study: The authors of the COPES trial randomized 157 patients with ACS and depressive symptoms to receive usual care or enhanced depression care for six months. Patients in the enhanced care group were allowed to choose whether they would receive medication, problem-solving psychotherapy, or both. In contrast, depression treatment for those in the usual care group was left up to their regular managing physician; the physicians were notified if their patients had elevated depressive symptoms. A separate cohort of 80 nondepressed patients with ACS was also observed during the study. The primary outcome was satisfaction with depression care; the first occurrence of a major adverse cardiac event was recorded as a secondary outcome.

Results: By the end of the study, both antidepressant and psychotherapy use were greater in the enhanced care group (48 and 39 percent, respectively) than in the usual care group (30 and 12 percent, respectively). Significantly more patients in the enhanced care group believed that their depression care was very good compared with patients in the usual care group (54 versus 19 percent). Although depressive symptoms improved in both groups, greater improvement occurred in the enhanced care group than in the usual care group (mean of 5.7-point reduction versus 1.9-point reduction on the Beck Depression Inventory). The major adverse cardiac event rate in the enhanced care group was similar to that in the nondepressed observational cohort (4 versus 6 percent, respectively), and was significantly lower than in the usual care group (13 percent).

Conclusion: The authors conclude that allowing patients with ACS and depressive symptoms to choose the type of depression treatment significantly improves their satisfaction with care. Fewer subsequent cardiovascular events occurred in this group; however, the authors caution that their study was not fully powered to investigate this outcome.

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