Trial reportTrials2018
Assessing the effectiveness of Enhanced Psychological Care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): a pilot cluster randomised controlled trial.
Trial report in Trials, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 3 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation.The Cochrane database of systematic reviews · 2024Pooled it
- Psychological and pharmacological interventions for depression in patients with coronary artery disease.The Cochrane database of systematic reviews · 2021Pooled it
- Behavioural activation therapy for depression in adults with non-communicable diseases.The Cochrane database of systematic reviews · 2020Pooled it
- Trial
- Metacognitive Therapy in Cardiac Rehabilitation: Staff Barriers and Enablers to Training in an Evidence-Based Psychological Treatment for Anxiety and Depression.Journal of the American Heart Association · 2026Article
- Efficacy and safety of behavioural activation on depression in people with co-occurring non-communicable diseases: systematic review and meta-analysis.BJPsych open · 2025Review
- Differential associations of emotional and physical domains of the MacNew Heart with changes in 6-min walking test.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2023Article
- Multimorbidity and adverse longitudinal outcomes among patients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia.Frontiers in medicine · 2023Article
- Optimizing the development and evaluation of complex interventions: lessons learned from the BetterBirth Program and associated trial.Implementation science communications · 2020Article
- Impact of Rehabilitation on Outcomes after TAVI: A Preliminary Study.Journal of clinical medicine · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors.
Funding
Abstract
backgroundAround 17% of people attending UK cardiac rehabilitation programmes have depression. Optimising psychological wellbeing is a rehabilitation goal, but provision of psychological care is limited. We developed and piloted an Enhanced Psychological Care (EPC) intervention embedded within cardiac rehabilitation, aiming to test key areas of uncertainty to inform the design of a definitive randomised controlled trial (RCT) and economic evaluation.
methodsAn external pilot randomised controlled trial (RCT) randomised eight cardiac rehabilitation teams (clusters) to either usual care of cardiac rehabilitation provision (UC), or EPC in addition to UC. EPC comprised mental health care coordination and patient-led behavioural activation with nurse support. Adults eligible for cardiac rehabilitation following an acute coronary syndrome and identified with new-onset depressive symptoms during an initial nurse assessment were eligible. Measures were performed at baseline and 5- and 8-month follow-ups and compared between EPC and UC. Team and participant recruitment and retention rates, and participant outcomes (clinical events, depression, anxiety, health-related quality of life, patient experiences, and resource use) were assessed.
resultsEight out of twenty teams were recruited and randomised. Of 614 patients screened, 55 were eligible and 29 took part (5%, 95% CI 3 to 7% of those screened), with 15 patient participants cluster randomised to EPC and 14 to UC. Nurse records revealed that 8/15 participants received the maximum number of EPC sessions offered; and 4/15 received no sessions. Seven out of fifteen EPC participants were referred to another NHS psychological service compared to none in UC. We followed up 27/29 participants at 5 months and 17/21 at 8 months. The mean difference (EPC minus UC) in depressive symptoms (Beck Depression Inventory) at follow-up (adjusting for baseline score) was 1.7 (95% CI - 3.8 to 7.3; N = 26) at 5 months and 4.4 (95% CI - 1.4 to 10.2; N = 17) at 8 months. DISCUSSION: While valued by patients and nurses, organisational and workload constraints are significant barriers to EPC implementation. There remains a need to develop and test new models of psychological care within cardiac rehabilitation. Our study offers important data to inform the design of future trials of similar interventions.
trial registrationISRCTN34701576 . Registered on 29 May 2014. Funding details: UK NIHR HTA Programme (project 12/189/09).
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