A Collaborative Care Program to Improve Treatment of Depression and Anxiety Disorders in Cardiac Patients

For this trial, the investigators propose a prospective trial of a collaborative care
program to identify and treat depression, generalized anxiety disorder (GAD), and panic
disorder (PD) among patients admitted to the hospital for an acute cardiac illness (acute
coronary syndrome [ACS], congestive heart failure [CHF], or arrhythmia). Such assessment
and treatment for depression/GAD/PD will begin in the hospital, and ongoing management will
continue for six months following discharge.

The investigators hypothesize that this model will lead to increased treatment rates,
improved mood, reduced anxiety, and improved medical outcomes in this vulnerable population.
If this model is effective, it could be implemented clinically to provide better and more
complete care to patients hospitalized with acute cardiac illness, for whom depression and
anxiety may be a risk factor for complications and death.

This will be a two-arm, single-blind randomized controlled trial, with one-half of patients
randomized to collaborative care and one-half randomized to the control condition (usual
care). Psychiatric treatment in the intervention arm will be provided in concert with
patients' primary care physicians (PCPs)—with PCPs prescribing all medications—within a
framework supervised by a psychiatrist.

The investigators will enroll patients who have any (or all) of the three included
psychiatric diagnoses to improve the utility of the intervention. The investigators have
chosen to enroll patients with several different cardiac diagnoses. This will allow the
researchers to include patients with heterogeneous diagnoses and illness severity to
determine if our intervention is effective in a broad population of patients with heart
disease. The investigators will study an intervention targeting depression, GAD, and PD:
all three disorders are disabling and associated with adverse cardiovascular outcomes,
treatments for the conditions are highly similar, the investigators can treat patients who
have more than one disorder, and a prior outpatient program successfully simultaneously
addressed more than one mental health condition.

The project will involve: (1) screening patients for depression, GAD, and PD as part of
usual clinical care, (2) evaluation of positive-screen patients by a study social work care
manager, (3) a multicomponent in-hospital intervention (for collaborative care patients)
that involves patient education, specialist-provided treatment recommendations, and a goal
of in-hospital treatment initiation, and (4), after discharge, continued phone-based
evaluation and care coordination with PCPs to provide stepwise treatment in the
collaborative care arm. The intervention has been designed to be low-cost, low-burden, and
easily generalizable to other settings.