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The Effect of a Telephone Counseling Intervention on Self-Rated Health of Cardiac Patients

From Harvard Medical School (K.Z.B., O.A., P.H.S., S.E.L., T.J.M.), Harvard Pilgrim Health Care (K.Z.B., O.A., M.G.M., J.C., T.J.M.), Beth Israel Deaconess Medical Center (S.E.L.), and Brigham and Women’s Hospital (P.H.S.), Boston, Massachusetts.

Address correspondence and reprint requests to Thomas J. McLaughlin, ScD, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215. E-mail: thomas_mclaughlin{at}hms.harvard.edu

Objective: The objective of this study was to evaluate the effectiveness of a telephone-based intervention on psychological distress among patients with cardiac illness.

Methods: We recruited hospitalized patients surviving an acute coronary syndrome with scores on the Hospital and Anxiety Depression Scale (HADS) indicating mild to severe depression and/or anxiety at 1 month postdischarge. Recruited patients were randomized into either an intervention or control group. Intervention patients received up to six 30-minute telephone-counseling sessions focused on identifying cardiac-related fears. Control patients received usual care. For both groups, we collected patients’ responses to the HADS and to the Global Improvement (CGI-I) subscale of the Clinical Global Impressions (CGI) Scale at baseline and at 2, 3, and 6 months postbaseline using Interactive Voice Recognition (IVR) technologies. We used mixed-effects analysis to estimate patients’ changes in CGI-I measures over the three time points of data collection postbaseline.

Results: We enrolled 100 patients, and complete CGI-I measures were collected for 79 study patients. The mean age was 60 years (standard deviation = 10), and 67% of the patients were male. A mixed-effects analysis confirmed that patients in the intervention group had significantly greater improvements in self-rated health (SRH) between baseline and month 3 than the control group (p = .01). Between month 3 and month 6, no significant differences in SRH improvements were observed between the control and intervention groups.

Conclusions: Study patients reported greater SRH improvement resulting from the telephone-based intervention compared with control subjects. Future research should include additional outcome measures to determine the effect of changes in SRH on patients with comorbid physical and emotional disorders.

Key Words: adjustment to chronic disease • cardiac disease • psychological distress • randomized controlled trial • self-rated health • telephone counseling

Abbreviations: ACS = acute coronary syndrome; ADL = activities of daily living; CAD = coronary artery disease; CGI = Clinical Global Impressions Scale; CGI-I = Global Improvement subscale of the Clinical Global Impressions (CGI) Scale; ENRICHD = Enhancing Recovery in Heart Disease Patients trial; HADS = Hospital and Anxiety Depression Scale; HTS = Healthcare Technology Systems; ICD-9 = International Classification of Diseases, Ninth Edition; IRB = Institutional Review Boards; IVR = interactive voice recognition; MI = myocardial infarction; SADHART = the Sertraline Antidepressant Heart Attack Randomized Trial; SRH = self-rated health.

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