CODIACS-QoL

Clinical Trial Details

Comparison of Depression Identification After Acute Coronary Syndrome: Quality of Life and Cost Outcomes

The purpose of this study is to examine, in a randomized controlled trial, the benefits and costs of the American Heart Association's (AHA) advisory for depression screen and treatment of post-acute coronary syndrome patients.

Key Findings

In post-ACS patients with no prior history of depression, there was no significant difference in QALY’s or depression-free days for depression identification after acute coronary syndrome in the three groups studied.

Swipe table left to see full data

CODIACS-QoL
18 MonthsScreen 1
depression screening and treatment
Screen 2
screen and notify PCP
Screen 3
usual care; no screening
P
QALY change-0.02 [0.09]-0.02 [0.08]-0.02 [0.08]0.76
Depression-free days

Cumulative mean days 343.0 [185.3]
Cumulative mean days 342.5 [190.7]Cumulative mean days 352.4 [185.8] 0.65

CODIAC QoL: Depression screening after ACS

Principal investigator Ian M. Kronish, MD, MPH, of Columbia University discusses the results of the CODIAC QoL study presented at ACC19. The trial looked at whether screening patients for depression post-ACS had an impact on treatment levels and outcomes.

Purpose: To examine quality of life benefits of depression screening and treatment in patients after acute coronary syndrome.

Trial Design: 1501 post-acute coronary syndrome patients hospitalized in the past 2-12 months. Randomized, controlled trial; patients from 4 geographically different health care systems randomized to 1. depression screening and treatment, 2. screen and notify primary care provider, or 3. no depression screening. Screening was done using the 8-item Patient Health Questionnaire (PHQ-8)

Primary Endpoints: change in quality adjusted life years (QALY’s) from baseline through 18 months.

Results: Quality-adjusted life years (QALYs) at 18 months: p=0.76

  • Group 1. depression screening and treatment: -0.02 [0.09]
  • Group 2. screen and notify primary care provider: -0.02 [0.08]
  • Group 3. usual care - no depression screening: -0.02 [0.08]

Conclusion: In post-ACS patients with no prior history of depression, there was no significant difference in QALY’s or depression-free days for depression identification after acute coronary syndrome in the three groups studied.

Background

This trial examines the quality of life benefits of depression screening and treatment in patients after acute coronary syndrome.

Trial design: randomized, controlled; patients from 4 geographically different health care systems randomized to 1. depression screening and treatment, 2. screen and notify primary care provider, or 3. usual care - no depression screening. Screening was done using the Depressive symptom screener. Treatment was based on patient preference and included cognitive behavioral therapy (CBT) or antidepressants.

Trial population: 1501 post-acute coronary syndrome patients (hospitalized 2-12 months prior). 18-month follow-up.

Primary endpoints: change in quality adjusted life years (QALY’s) from baseline through 18 months. QALYs capture the degree to which a person’s life is detrimentally affected by physical or mental disability over time, with one point representing one year of perfect health and zero points representing death.

Abstract: "QALYs capture the degree to which a person’s life is detrimentally affected by physical or mental disability over time, with one point representing one year of perfect health and zero points representing death."

Secondary endpoints: depression-free days.

Results:

Primary endpoints: 7.1 % of those screened were found to be depressed using the 8-item Patient Health Questionnaire (PHQ-8) to screen for depression.

Quality-adjusted life years (QALYs) at 18 months: p=0.76

  • Group 1. depression screening and treatment: -0.02 [0.09]
  • Group 2. screen and notify primary care provider: -0.02 [0.08]
  • Group 3. usual care - no depression screening: -0.02 [0.08]

Secondary endpoints: Mean depression-free days: 343.0 [185.3] - p=0.65

  • Group 1. depression screening and treatment: 342.5 [190.7]
  • Group 2. screen and notify primary care provider: 352.4 [185.8]

Sponsor:
Columbia University

Collaborators:
National Heart, Lung, and Blood Institute (NHLBI)
Duke University
HealthPartners Institute
Kaiser Foundation Research Institute

References

Key Words
Acute coronary syndrome, Depression, Antidepressant drugs, depression, acute coronary syndrome

Related Clinical Topics
Acute Coronary Syndrome, quality

See more AHA coverage of science presented at ACC.19