O'Neil Adrienne, Hawkes Anna L, Atherton John J, Patrao Tania A, Sanderson Kristy, Wolfe Rory, Taylor C Barr, Oldenburg Brian
Barwon Psychiatric Research Unit, Deakin University, Geelong, Australia.
Eur J Prev Cardiol. 2014 Jan;21(1):30-8. doi: 10.1177/2047487312460515. Epub 2012 Sep 6.
Recently, we found a telephone-delivered secondary prevention programme using health coaching ('ProActive Heart') to be effective in improving a range of key behavioural outcomes for myocardial infarction (MI) patients. What remains unclear, however, is the extent to which these treatment effects translate to important psychological outcomes such as depression and anxiety outcomes, an issue of clinical significance due to the substantial proportion of MI patients who experience depression and anxiety. The objective of the study was to investigate, as a secondary hypothesis of a larger trial, the effects of a telephone-delivered health coaching programme on depression and anxiety outcomes of MI patients.
Two-arm, parallel-group, randomized, controlled design with six-months outcomes.
Patients admitted to one of two tertiary hospitals in Brisbane, Australia following MI were assessed for eligibility. Four hundred and thirty patients were recruited and randomly assigned to usual care or an intervention group comprising up to 10 telephone-delivered 'health coaching' sessions (ProActive Heart). Regression analysis compared Hospital Anxiety and Depression Scale scores of completing participants at six months (intervention: n = 141 versus usual care: n = 156).
The intervention yielded reductions in anxiety at follow-up (mean difference = -0.7, 95% confidence interval=-1.4,-0.02) compared with usual care. A similar pattern was observed in mean depression scores but was not statistically significant.
The ProActive Heart programme effectively improves anxiety outcomes of patients following myocardial infarction. If combined with psychological-specific treatment, this programme could impact anxiety of greater intensity in a clinically meaningful way.
最近，我们发现一项通过健康指导进行电话干预的二级预防项目（“积极心脏”项目）在改善心肌梗死（MI）患者一系列关键行为结果方面是有效的。然而，目前尚不清楚这些治疗效果在多大程度上能转化为诸如抑郁和焦虑等重要的心理结果，鉴于相当比例的MI患者会出现抑郁和焦虑，这是一个具有临床意义的问题。本研究的目的是作为一项更大规模试验的次要假设，调查电话健康指导项目对MI患者抑郁和焦虑结果的影响。
双臂、平行组、随机对照设计，随访六个月。
对澳大利亚布里斯班两家三级医院之一因心肌梗收入院的患者进行资格评估。招募了430名患者，并将他们随机分配到常规护理组或干预组，干预组包括最多10次电话健康指导课程（“积极心脏”项目）。回归分析比较了六个月时完成研究的参与者的医院焦虑抑郁量表得分（干预组：n = 141，常规护理组：n = 156）。
与常规护理相比，干预组在随访时焦虑水平降低（平均差异=-0.7，95%置信区间=-1.4，-0.02）。抑郁平均得分也呈现类似趋势，但无统计学意义。
“积极心脏”项目有效改善了心肌梗死患者的焦虑结果。如果与针对心理问题的特定治疗相结合，该项目可能会以具有临床意义的方式影响更严重程度的焦虑。
