University Times

Depression is common among patients following cardiac artery bypass graft (CABG) surgery. Depending on the assessment instrument and cut-off point used, studies have found that 16-47 percent of cardiac bypass patients reported depressive symptoms.

Furthermore, these symptoms tended to persist in about half of the patients up to three years later, and therefore couldn’t be attributed solely to the psychic stress of major surgery.

Yet, no research project has ever examined the impact of treating post-surgical depression on CABG patients’ quality of life, cardiovascular morbidity and health care costs — until now.

Beginning last July and continuing through June 2007, a Pitt project called “Bypassing the Blues” is testing the hypothesis that depressive symptoms among CABG patients can be relieved through an intervention program that’s already shown good results in treating depression, panic attacks and generalized anxiety depression.

The intervention involves a nurse care manager periodically telephoning patients, beginning two weeks after surgery — checking to see if their post-operative depressive symptoms have abated and, if not, telling them about various treatment options for depression. Nurses work closely with the patients’ primary care physicians.

The study recently began recruiting patients. Eventually, researchers plan to recruit 300 CABG patients who report depressive symptoms three-to-five days after surgery at UPMC Presbyterian, UPMC Shadyside, Allegheny General and West Penn hospitals. Half of these patients will receive the intervention. The other 150 will receive “usual care,” i.e., whatever treatment they normally would get from their doctors.

Another 150, non-depressed CABG patients will serve as a control group for the depressed patients receiving “usual care.”

The study is “slightly contaminated” in that physicians of the 150 depressed patients not receiving the intervention will be told that their patients reported depressive symptoms, said study principal investigator Bruce L. Rollman, a Pitt associate professor of medicine and psychiatry.

“Ethically, you need to inform these patients’ physicians because depression is associated with serious morbidity, including suicide, so you can’t just diagnose people with depression and not tell their doctors,” Rollman said.

“Bypassing the Blues” is funded by a $4.5 million grant from the National Heart, Lung and Blood Institute (NHLBI).

Nearly 60,000 CABG surgeries are performed annually in the United States at an average charge of approximately $60,000, mainly to relieve angina and improve quality of life. Although it never occurs to many CABG patients that they may be suffering from depression (“Part of the problem is, people just assume that you’re supposed to feel down and lacking in energy after major surgery,” Rollman said), post-surgical depression among CABG patients has been well-documented.

“So why is this the first study that’s looking at the impact of treating post-CABG depression on quality of life, cardiovascular morbidity and health care costs?” Rollman said, echoing a reporter’s question. “I think it’s because a lot of the scientific community works in silos, so that depression researchers are looking one way, heart-lung-and-blood researchers are focused in another direction, and so forth, whereas ‘Bypassing the Blues’ is really a cross-disciplinary study.”

Rollman said the American Heart Association rejected an earlier proposal for a similar study because it lacked a placebo. “Cardiologists are just used to dealing with studies where you have a placebo control,” he said, “and ours is a ‘usual care’ control group.”

Co-principal investigator for “Bypassing the Blues” is Charles F. Reynolds, professor of psychiatry and neuroscience at Pitt’s medical school and Western Psychiatric Institute and Clinic.
—Bruce Steele