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The Bypassing the Blues Treatment Protocol: Stepped Collaborative Care for Treating Post-CABG Depression

From the Division of General Internal Medicine (B.L.R., B.H.B., M.S.L.), Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Biostatistics (S.M.), University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; Department of Psychiatry (H.C.S.), Weill Cornell Medical College, White Plains, New York; and Department of Psychiatry (C.F.R.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Address correspondence and reprint requests to Bruce L. Rollman, 230 McKee Place, Suite 600, Pittsburgh, PA 15213-2582. E-mail: rollmanbl{at}upmc.edu

Objective: To present the design of the Bypassing the Blues (BtB) study to examine the impact of a collaborative care strategy for treating depression among patients with cardiac disease. Coronary artery bypass graft (CABG) surgery is one of the most common and costly medical procedures performed in the US. Up to half of post-CABG patients report depressive symptoms, and they are more likely to experience poorer health-related quality of life (HRQoL), worse functional status, continued chest pains, and higher risk of cardiovascular morbidity independent of cardiac status, medical comorbidity, and the extent of bypass surgery.

Methods: BtB was designed to enroll 450 post-CABG patients from eight Pittsburgh-area hospitals including: (1) 300 patients who expressed mood symptoms preceding discharge and at 2 weeks post hospitalization (Patient Health Questionnaire (PHQ-9) 10); and (2) 150 patients who served as nondepressed controls (PHQ-9 <5). Depressed patients were randomized to either an 8-month course of nurse-delivered telephone-based collaborative care supervised by a psychiatrist and primary care expert, or to their physicians’ "usual care." The primary hypothesis will test whether the intervention can produce an effect size of 0.5 improvement in HRQoL at 8 months post CABG, as measured by the SF-36 Mental Component Summary score. Secondary hypotheses will examine the impact of our intervention on mood symptoms, cardiovascular morbidity, employment, health services utilization, and treatment costs.

Results: Not applicable.

Conclusions: This effectiveness trial will provide crucial information on the impact of a widely generalizable evidence-based collaborative care strategy for treating depressed patients with cardiac disease.

Key Words: depression • coronary artery bypass surgery • randomized clinical trial • collaborative care • coronary artery disease

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