No survival benefit for heart disease patients treated for depression and low social support

June 17, 2003

The first major study to evaluate the effects of treating depression and low social support in recent heart attack patients found no reduction in deaths or second heart attacks; however, study participants showed significant improvement in depression and social functioning.

Results from the Enhancing Recovery in Coronary Heart Disease Patients Study (ENRICHD), which was supported by the National Heart, Lung, and Blood Institute (NHLBI), are published in the June 18 "theme depression issue" of the Journal of the American Medical Association (JAMA). Susan Czajkowski, Ph.D., ENRICHD project officer and an NHLBI research psychologist, will discuss the results at a June 17 JAMA press briefing at the National Press Club in Washington, D.C.

Social isolation and depression are risk factors for death and recurrent heart attack in heart disease patients. About 25 percent of heart disease patients have one of these conditions after a heart attack, a situation that places them at a 3-to-4 times higher risk of death.

ENRICHD enrolled 2, 481 patients within 28 days of a heart attack. Patients had depression, low social support, or both. After random assignment to a "treatment" or "usual medical care" group, all patients received written information on heart disease risk factors. The "treatment" group also received 6 months of cognitive behavioral therapy. During these sessions, trained counselors provided cognitive therapy, which seeks to modify or eliminate thought patterns contributing to the patient's symptoms, and behavioral therapy which helps patients change habits. Some patients received antidepressants.

Survival at 29 months was virtually identical in both groups - 75.9 percent in usual care and 75.8 percent in the treatment group. The risk of death or of a second heart attack was lower among patients who were taking antidepressants, regardless of whether they received counseling. However, this finding is not definitive because the study was not specifically designed to test the effects of antidepressants. Future studies will be needed to address this question.

ENRICHD's depression/social support findings reveal the benefits of treatment on quality of life. At 6 months, depressed patients in the treatment group had a 57 percent reduction in depression versus a 47 percent reduction in the usual care group. Patients with low social support in the treatment group had a 27 percent improvement in this condition compared to an 18 percent improvement in usual medical care.

According to Czajkowski, these findings show that treatment can have a significant impact on heart attack patients' psychosocial functioning. She adds that the ENRICHD results offer an important public health message: Heart attack patients who show signs of depression should be evaluated and treated according to existing guidelines. At present, only an estimated 25 percent of heart attack patients with depression are being treated for this condition.
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The following ENRICHD investigators are available for interviews:

  • Dr. Czajkowski. For interviews, contact the NHLBI Communications Office at 301-496-4236.
  • Lisa Berkman, Ph.D., ENRICHD study chair and professor at the Harvard School of Public Health, Boston, MA. For an interview, contact Kevin Myron at 617-432-3952
  • Allan S. Jaffe, M.D., ENRICHD study co-chair and cardiologist and professor of medicine at the Mayo Clinic, Rochester, MD. For an interview, contact Dr. Jaffe at 507-284-4278.
  • Robert M. Carney, Ph.D., ENRICHD investigator and professor of psychiatry at Washington University in St. Louis, MO. For an interview, contact Dr. Carney at 314-286-1300.

    NHLBI is part of the National Institutes of Health, the Federal Government's primary agency for biomedical and behavioral research. NIH is a component of the U.S. Department of Health and Human Services. NHLBI press releases and other materials are available online at http://www.nhlbi.nih.gov.

    NIH/National Heart, Lung and Blood Institute

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