Journal of affective disorders · 2025
Impact of collaborative care model treatment for depression and anxiety on cardiovascular risk factors using electronic health record data.
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Carroll Allison J, Philbin Sarah E, Sanuade Olutobi A, Fu Emily S, Carlo Andrew D, Pedamallu Havisha, Borisuth Saneha, Rosenthal Lisa J, Rado Jeffrey T, Jordan Neil, Burnett-Zeigler Inger E, Brown C Hendricks, Smith Justin D
Аннотация
BACKGROUND: Primary care patients with depression or anxiety are at higher risk for cardiovascular disease. Those who engage in integrated mental health treatment may also improve their cardiovascular health.
METHODS: We conducted secondary analysis of electronic health record-extracted data related to a pragmatic, implementation trial of the collaborative care model for depression and anxiety (CoCM; NCT04321876). Primary care patients with elevated depressive/anxiety symptoms (N = 3252) in 11 primary care clinics were classified as CoCM Patients (n = 718), Not Referred to CoCM (n = 1348), or Not Engaged in CoCM (n = 1459). Cardiovascular health measures included blood pressure (BP; mmHg), total cholesterol (mg/dL), HbA1c (%), and body mass index (BMI; kg/m2). Primary analyses were linear regressions evaluating associations of CoCM treatment (vs. Not Referred, vs. Not Engaged) with changes in cardiovascular health, adjusted for demographics, cardiovascular diagnoses, and medications.
RESULTS: At baseline, CoCM Patients had poorer cardiovascular health than Not Referred (higher systolic BP, total cholesterol, BMI) and better cardiovascular health than Not Engaged (lower total cholesterol, HbA1c). CoCM Patients, vs. Not Referred, had small decreases in total cholesterol (B = -0.44, 95 % CI: -0.72, -0.17) and increases in BMI (B = 0.18, 95 % CI: 0.03, 0.34). CoCM Patients did not differ from Not Engaged patients on cardiovascular health outcomes (all ps > 0.05).
DISCUSSION: Differences in cardiovascular health profiles were evident prior to treatment. Patients who bengaged in CoCM treatment, compared to patients not referred to CoCM, evidenced small improvements in total cholesterol and increases in BMI. Widespread implementation of integrated mental health treatment may have implications for population cardiovascular health.
METHODS: We conducted secondary analysis of electronic health record-extracted data related to a pragmatic, implementation trial of the collaborative care model for depression and anxiety (CoCM; NCT04321876). Primary care patients with elevated depressive/anxiety symptoms (N = 3252) in 11 primary care clinics were classified as CoCM Patients (n = 718), Not Referred to CoCM (n = 1348), or Not Engaged in CoCM (n = 1459). Cardiovascular health measures included blood pressure (BP; mmHg), total cholesterol (mg/dL), HbA1c (%), and body mass index (BMI; kg/m2). Primary analyses were linear regressions evaluating associations of CoCM treatment (vs. Not Referred, vs. Not Engaged) with changes in cardiovascular health, adjusted for demographics, cardiovascular diagnoses, and medications.
RESULTS: At baseline, CoCM Patients had poorer cardiovascular health than Not Referred (higher systolic BP, total cholesterol, BMI) and better cardiovascular health than Not Engaged (lower total cholesterol, HbA1c). CoCM Patients, vs. Not Referred, had small decreases in total cholesterol (B = -0.44, 95 % CI: -0.72, -0.17) and increases in BMI (B = 0.18, 95 % CI: 0.03, 0.34). CoCM Patients did not differ from Not Engaged patients on cardiovascular health outcomes (all ps > 0.05).
DISCUSSION: Differences in cardiovascular health profiles were evident prior to treatment. Patients who bengaged in CoCM treatment, compared to patients not referred to CoCM, evidenced small improvements in total cholesterol and increases in BMI. Widespread implementation of integrated mental health treatment may have implications for population cardiovascular health.