Herrmann-Lingen Christoph, Sadlonova Monika, Becker Ingrid, Bersch Kristina, Geiser Franziska, Hellmich Martin, Kindermann Ingrid, Michal Matthias, Nöhre Mariel, Petersmann Astrid, Wachter Rolf, Belnap Birgit Herbeck, Albus Christian
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.
German Center for Cardiovascular Research (DZHK), partner site Lower Saxony, Göttingen, Germany.
Front Psychiatry. 2025 Jan 31;16:1494839. doi: 10.3389/fpsyt.2025.1494839. eCollection 2025.
Medical risk factors and psychological distress are important targets for secondary prevention of coronary heart disease (CHD). The multicenter randomized controlled TEACH study is the first trial testing a blended collaborative care (BCC) intervention vs. usual care in a cohort of only patients with CHD. The current manuscript analyzes the availability of distressed CHD patients for a BCC intervention trial and the baseline risk profile of the randomized cohort, especially focusing on sex differences.
Hospitalized CHD patients with positive HADS and/or PSS-4 screening were rescreened three months later and those still distressed were offered participation in the RCT if they had insufficiently controlled medical risk factors (smoking, physical inactivity, elevated blood pressure, LDL cholesterol, and/or HbA1c). The current manuscript describes the TEACH screening process and presents baseline data of the randomized cohort.
Of 2,785 screened patients, 457 patients with persistent distress and insufficiently controlled risk factors were randomized. Older age and lower distress but not sex independently predicted dropout before randomization. In the randomized cohort (mean age 62.9 ± 9.5 years, 77.4% men), women were older than men (p=0.025), more likely to be retired (52.4% vs. 38.6%; p=0.012) and to live without a partner (48.6% vs. 24.8%, p<0.001). Compared to men, they had lower diastolic blood pressure (p=0.003) but higher rates of physical inactivity (56.0% vs. 41.8%; p=0.012) and positive family history of premature atherosclerotic disease (45.7% vs. 29.8%; p=0.009). They also had a lower rate of previous coronary bypass surgery (21.0% vs. 39.2%, p<0.001). A mental disorder had been diagnosed in 54% of all randomized patients and 42% had previously received mental health treatment, both reported substantially more frequently by women than men (both p<0.001). Satisfaction with care before the trial did not differ by sex but was far lower for psychosocial care than for treatment of heart disease (p<0.001).
TEACH enrolled a patient sample with persisting distress and a typical risk factor profile. Women differed from men in relevant aspects of their RF profiles and mental health and should receive special attention in future analyses and treatment planning for patients with CHD.
German Clinical Trials Register, https://drks.de/search/de/trial/DRKS00020824, identifier DRKS00020824.
医学风险因素和心理困扰是冠心病（CHD）二级预防的重要目标。多中心随机对照TEACH研究是首个在仅患有冠心病的队列中测试混合协作护理（BCC）干预与常规护理对比的试验。本手稿分析了患有心理困扰的冠心病患者参与BCC干预试验的可能性以及随机分组队列的基线风险概况，尤其关注性别差异。
对住院且HADS和/或PSS - 4筛查呈阳性的冠心病患者在三个月后进行重新筛查，那些仍有心理困扰且医学风险因素（吸烟、缺乏运动、血压升高、低密度脂蛋白胆固醇和/或糖化血红蛋白）控制不佳的患者被邀请参与随机对照试验（RCT）。本手稿描述了TEACH筛查过程并呈现了随机分组队列的基线数据。
在2785名接受筛查的患者中，457名有持续心理困扰且风险因素控制不佳的患者被随机分组。年龄较大和心理困扰程度较低但并非性别独立预测随机分组前退出试验的情况。在随机分组队列中（平均年龄62.9±9.5岁，77.4%为男性），女性比男性年龄更大（p = 0.025），更有可能退休（52.4%对38.6%；p = 0.012）且独居（48.6%对24.8%，p < 0.001）。与男性相比，她们舒张压较低（p = 0.003），但缺乏运动的比例较高（56.0%对41.8%；p = 0.012）以及有早发性动脉粥样硬化疾病家族史阳性的比例较高（45.7%对29.8%；p = 0.009）。她们既往冠状动脉搭桥手术的比例也较低（21.0%对39.2%，p < 0.001）。在所有随机分组的患者中，54%被诊断患有精神障碍，42%曾接受过心理健康治疗，女性报告的这两项比例均显著高于男性（均p < 0.001）。试验前对护理的满意度在性别上无差异，但心理社会护理的满意度远低于心脏病治疗的满意度（p < 0.001）。
TEACH纳入了有持续心理困扰和典型风险因素概况的患者样本。女性在风险因素概况和心理健康的相关方面与男性不同，在未来对冠心病患者的分析和治疗规划中应给予特别关注。
德国临床试验注册中心，https://drks.de/search/de/trial/DRKS00020824，标识符DRKS00020824
