Author + information
- Katharine Edwards1,
- Derik Hossepian2,
- Audrey Johnson2,
- Catherine Dao3,
- Sonia Shah4 and
- William Fearon5
- 1Stanford University, Stanford, CA, California, United States
- 2Palo Alto University, Palo Alto, California, United States
- 3Washington Township Medical Foundation, Fremont, California, United States
- 4Stanford University, Stanford, California, United States
- 5Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States
Depression occurs in 15-40% of cardiac surgery patients and has been associated with cardiac morbidity, re-hospitalization, decreased functional status, and lower quality of life (QOL). Cognitive behavioral therapy (CBT) is an effective, evidence-based treatment for depression and anxiety. Preliminary studies have shown transcatheter aortic valve replacement (TAVR) to benefit physical function and QOL, with modest gains in mental health compared to standard therapy. However, to date no published trials have looked at the impact of treating depression or anxiety in these patients.
Of 129 patients consented for mental health screening prior to TAVR, 44 (34%) endorsed clinically significant anxiety or depression at baseline. Patients were randomized to brief bedside CBT delivered during their hospital stay (n=25) or treatment as usual control (n=19). Self-report measures for depression (Beck Depression Inventory-II) and QOL (Minnesota Living with Heart Failure Questionnaire) were administered again at discharge and 1-month follow up.
Despite randomization, baseline depression scores were not equivalent between groups (F=4.45, p<0.05) and standard ANOVA comparisons were non-significant. However, mean change on the BDI-II from baseline to 1-month follow up was clinically significant for the CBT group (Δ=-6.78) but not the control group (Δ=-4.75) and change scores from baseline to 1-month follow up were greater for the CBT group (Δ=-2.85) than the control group (Δ=-0.54; t=-1.54, p=0.05). Mean change in QOL as measured by the MLHFQ was moderately-to-markedly improved in the CBT group (Δ=19.21) vs. mildly improved in the control group (Δ=13.54).
Previous studies have established that brief CBT targeting post-operative depression and anxiety are feasibly and acceptable for patients undergoing CABG surgery. This is the first study to examine a similar intervention for TAVR patients, and data suggest that brief CBT is a promising intervention for improving mood and QOL post discharge. Additional findings will be presented regarding health care utilization and predictors of post-operative depression and anxiety.
STRUCTURAL: Valvular Disease: Aortic