Efficacy of team‑based collaborative care for distressed patients in secondary prevention of chronic coronary heart disease: Results from the multicenter, randomized controlled TEACH trial.

Abstract

INTRODUCTION Coronary heart disease (CHD) has serious implications for patients´ quality of life (QoL). Psychological distress affects 15 to 40% of patients with CHD and is robustly associated with poorer prognosis. Blended collaborative care (BCC), a telephone-delivered intervention involving non-physician care managers that address both psychological and medical factors can be applied for secondary prevention of CHD. METHODS We conducted the multicenter, randomized controlled TEACH trial that investigated the efficacy of a BCC intervention (TeamCare) in distressed CHD patients. The primary aim was to examine the treatment response rate of TeamCare defined as ≥ 50% improvements in health-related QoL (HRQoL, assessed by HeartQoL) after 12 months compared to usual care (UC). Secondary endpoints were changes in HRQoL, psychological and medical factors, and satisfaction with care. RESULTS In total, 457 patients (mean age 62.9 ± 9.5 years, 23% females) were randomized to TeamCare (n=230) or UC (n=227). At 12 months, TeamCare patients showed a significantly higher proportion of treatment response on HeartQoL compared to UC (19% vs. 10%, respectively). TeamCare yielded significantly greater improvements in HeartQoL scores: global (d=0.338), physical (d=0.270), and emotional (d=0.382). Further, TeamCare led to a significantly greater decrease in depression (d=-0.329), anxiety (d=-0.300), perceived stress (d=-0.233), and medical risk score (d=-0.235). Finally, BCC patients showed a higher satisfaction with overall treatment and psychosocial care. CONCLUSION The TEACH study is the first ever performed BCC trial in distressed CHD patients in Europe. The BCC intervention has the potential to significantly improve secondary prevention in distressed CHD patients.