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The aim of this study was to examine whether collaborative care can improve clinical outcomes in patients with both ACS and depression and/or anxiety.
In the present study, depression and/or anxiety were screened by using SDS and SAS questionnaire in 318 patients with acute coronary syndrome(ACS), and 96 (30.19%) ACS patients with depression and/or anxiety disorders were randomized into the multidisciplinary collaborative care management group (MCCM, n=49) and the usual physician care management group (UPCM, n=47). The ACS patients withoutdepression and/or anxiety were served as control group. One year of multidisciplinary collaborative care was provided by multidisciplinary team to the patients in the MCCM group.
The effect and adherence for cardiovascular risk factors management, psychological interventions and health education were followed up at 6 months after enrollment. At 1 year follow-up, cardiac outcomes for patients in UPCM group was compareded with patients with ACS (ACS ptients without depression and/or anxiety). The effect of multidisciplinary collaborative care management were evaluated in the patients in MCCM group compared with UPCM group at 1 year.
At 6 months after ACS, mental disorder are associated with increased risk for clinical outcomes, most risk factors worsened more significantly in patients in UPCM group compared with ACS group. The majority of parameters for risk factors improved more significantly in the patients in the MCCM group compared with UPCM group at 6 months follow up.
At 1 year follow-up, cardiac death (p=0.03), composite events of cardiac death and non-fatal MI (p=0.002), episodes of angina (p 0.0005) occured more significantly in patients in UPCM group than ACS group. At 1 year after multidisciplinary collaborative care management, cardiac outcome measures for the patients in the MCCM group were significantly better for composite events of cardiac death and non-fatal MI (6.12% vs 23.40%, p=0.016), cardiac function (NYHA class III or IV, 0% vs 25%, p=0.05), and angina pectoris attacks (21.28% vs 85%, p 0.0005), compared with the patients in UPCM group. The patients in MCCM group achieved significant mental and social functioning improvements on appetite (p 0.0005), sleep (p 0.0005), and job back (p=0.007), compared with patients in UPCM group.
After ACS, 30.19% of patients had depression and/or anxiety disorders, which led to poorer modification of risk factors for coronary heart disease, and associated with poorer cardiac outcomes and reduced quality of life. The multidisciplinary collaborative care management had better effects on cardiac outcomes and quality of life in ACS patients with depression and/or anxiety.