An IT Approach to Implementing Depression Treatment in Cardiac Patients (iHeart DepCare)

Depression is common in patients with coronary heart disease and associated with increased
cardiac morbidity and mortality. Treating depressive symptoms appears to improve depressive
symptoms and quality of life. Despite expert recommendations to screen and treat depressive
symptoms fewer coronary heart disease patients engage in depression treatment than the
general population, perhaps due to 1) sub-optimal provider awareness and referral rates and
2) low self-efficacy, stigma and misattribution of depressive symptoms among coronary heart
disease patients. In addition, few real world theory-informed implementation trials exist for
improving screening and treatment in outpatient settings.

The specific aim is to determine whether an electronic shared decision making (eSDM) and
behavioral activation tool improves depressive symptoms and treatment initiation in coronary
heart disease patients with elevated depressive symptoms. To accomplish these aims, a hybrid
effectiveness-implementation trial will be conducted using a stepped wedge design across
socioeconomically diverse cardiology and primary care clinics.

Inclusion Criteria:

- History of coronary heart disease

- English or Spanish Speaking

- Elevated Depressive symptoms (PHQ9 ≥10)

Exclusion Criteria:

- Under the care of a psychiatrist (e.g., for schizophrenia)

- Diagnosis/history of psychosis or schizophrenia

- Diagnosis/history of bipolar disorder

- Attempted suicide

- Non-English or Spanish speaking

- Dementia or severe cognitive impairment

- Non-elevated depressive symptoms

- Alcohol or substance abuse

- Pregnancy