PT  - JOURNAL ARTICLE
AU  - Tully, Phillip J
AU  - Baumeister, Harald
TI  - Collaborative care for comorbid depression and coronary heart disease: a systematic review and meta-analysis of randomised controlled trials
AID  - 10.1136/bmjopen-2015-009128
DP  - 2015 Dec 01
TA  - BMJ Open
PG  - e009128
VI  - 5
IP  - 12
4099  - http://bmjopen.bmj.com/content/5/12/e009128.short
4100  - http://bmjopen.bmj.com/content/5/12/e009128.full
SO  - BMJ Open2015 Dec 01; 5
AB  - Objectives To systematically review the efficacy of collaborative care (CC) for depression in adults with coronary heart disease (CHD) and depression.Design Systematic review and meta-analysis.Data sources Electronic databases (Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, PsycINFO and CINAHL) were searched until April 2014.Inclusion criteria Population, depression comorbid with CHD; intervention, randomised controlled trial (RCT) of CC; comparison, either usual care, wait-list control group or no further treatment; and outcome, (primary) major adverse cardiac events (MACE), (secondary) standardised measure of depression, anxiety, quality of life (QOL) and cost-effectiveness.Data extraction and analysis RevMan V.5.3 was used to synthesise the data as risk ratios (RRs), ORs and standardised mean differences (SMD) with 95% CIs in random effect models.Results Six RCTs met the inclusion criteria and comprised 655 participants randomised to CC and 629 participants randomised to the control group (total 1284). Collaborative depression care led to a significant reduction in MACE in the short term (three trials, RR 0.54; 95% CI 0.31 to 0.95, p=0.03) that was not sustained in the longer term. Small reductions in depressive symptoms were evident in the short term (6 trials, pooled SMD −0.31; 95% CI −0.43 to −0.19, p<0.00001) and depression remission was more likely to be achieved with CC (5 trials, OR 1.77; 95% CI 1.28 to 2.44, p=0.0005). Likewise, a significant effect was observed for anxiety symptoms (SMD −0.36) and mental QOL (SMD 0.24). The timing of the intervention was a source of between-group heterogeneity for depression symptoms (between groups p=0.04, I2=76.5%).Conclusions Collaborative depression care did not lead to a sustained reduction in the primary MACE end point. Small effects were observed for depression, depression remission, anxiety and mental QOL.Trials registration number PROSPERO CRD42014013653.