Identification and characteristics of distressed patients with coronary heart disease and insufficiently controlled medical risk factors: baseline findings and sex differences from the multicenter TEACH trial
IntroductionMedical 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...
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2025-01-01
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| author | Christoph Herrmann-Lingen Christoph Herrmann-Lingen Monika Sadlonova Monika Sadlonova Monika Sadlonova Monika Sadlonova Monika Sadlonova Ingrid Becker Kristina Bersch Franziska Geiser Martin Hellmich Ingrid Kindermann Matthias Michal Mariel Nöhre Astrid Petersmann Astrid Petersmann Rolf Wachter Rolf Wachter Rolf Wachter Birgit Herbeck Belnap Birgit Herbeck Belnap Christian Albus |
| author_facet | Christoph Herrmann-Lingen Christoph Herrmann-Lingen Monika Sadlonova Monika Sadlonova Monika Sadlonova Monika Sadlonova Monika Sadlonova Ingrid Becker Kristina Bersch Franziska Geiser Martin Hellmich Ingrid Kindermann Matthias Michal Mariel Nöhre Astrid Petersmann Astrid Petersmann Rolf Wachter Rolf Wachter Rolf Wachter Birgit Herbeck Belnap Birgit Herbeck Belnap Christian Albus |
| author_sort | Christoph Herrmann-Lingen |
| collection | DOAJ |
| description | IntroductionMedical 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.MethodsHospitalized 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.ResultsOf 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).DiscussionTEACH 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.Clinical Trial RegistrationGerman Clinical Trials Register, https://drks.de/search/de/trial/DRKS00020824, identifier DRKS00020824. |
| format | Article |
| id | doaj-art-c083b643c4c24274bcf76e1bf2413e51 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Psychiatry |
| spelling | doaj-art-c083b643c4c24274bcf76e1bf2413e512025-01-31T06:40:06ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402025-01-011610.3389/fpsyt.2025.14948391494839Identification and characteristics of distressed patients with coronary heart disease and insufficiently controlled medical risk factors: baseline findings and sex differences from the multicenter TEACH trialChristoph Herrmann-Lingen0Christoph Herrmann-Lingen1Monika Sadlonova2Monika Sadlonova3Monika Sadlonova4Monika Sadlonova5Monika Sadlonova6Ingrid Becker7Kristina Bersch8Franziska Geiser9Martin Hellmich10Ingrid Kindermann11Matthias Michal12Mariel Nöhre13Astrid Petersmann14Astrid Petersmann15Rolf Wachter16Rolf Wachter17Rolf Wachter18Birgit Herbeck Belnap19Birgit Herbeck Belnap20Christian Albus21Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, Göttingen, GermanyGerman Center for Cardiovascular Research (DZHK), partner site Lower Saxony, Göttingen, GermanyDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, Göttingen, GermanyGerman Center for Cardiovascular Research (DZHK), partner site Lower Saxony, Göttingen, GermanyDepartment of Cardiothoracic and Vascular Surgery, University Medical Center Göttingen, Göttingen, GermanyDepartment of Geriatrics, University Medical Center Göttingen, Göttingen, GermanyDepartment of Psychiatry, Massachusetts General Hospital, Boston, MA, United StatesInstitute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Köln, GermanyClinical Trials Unit, University Medical Center Göttingen, Göttingen, GermanyDepartment of Psychosomatic Medicine and Psychotherapy, University Hospital of Bonn, University of Bonn, Bonn, GermanyInstitute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Köln, GermanyDepartment of Internal Medicine III, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany0Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany1Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany2Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany3Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, GermanyGerman Center for Cardiovascular Research (DZHK), partner site Lower Saxony, Göttingen, Germany4Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany5Central German Heart Alliance, Leipzig, GermanyDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany6Center for Behavioral Health and Smart Technology, University of Pittsburgh Medical School, Pittsburgh, PA, United States7Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Cologne, Köln, GermanyIntroductionMedical 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.MethodsHospitalized 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.ResultsOf 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).DiscussionTEACH 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.Clinical Trial RegistrationGerman Clinical Trials Register, https://drks.de/search/de/trial/DRKS00020824, identifier DRKS00020824.https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1494839/fullcoronary heart diseasecardiovascular risk factorspsychological distressblended collaborative caresex differences |
| spellingShingle | Christoph Herrmann-Lingen Christoph Herrmann-Lingen Monika Sadlonova Monika Sadlonova Monika Sadlonova Monika Sadlonova Monika Sadlonova Ingrid Becker Kristina Bersch Franziska Geiser Martin Hellmich Ingrid Kindermann Matthias Michal Mariel Nöhre Astrid Petersmann Astrid Petersmann Rolf Wachter Rolf Wachter Rolf Wachter Birgit Herbeck Belnap Birgit Herbeck Belnap Christian Albus Identification and characteristics of distressed patients with coronary heart disease and insufficiently controlled medical risk factors: baseline findings and sex differences from the multicenter TEACH trial Frontiers in Psychiatry coronary heart disease cardiovascular risk factors psychological distress blended collaborative care sex differences |
| title | Identification and characteristics of distressed patients with coronary heart disease and insufficiently controlled medical risk factors: baseline findings and sex differences from the multicenter TEACH trial |
| title_full | Identification and characteristics of distressed patients with coronary heart disease and insufficiently controlled medical risk factors: baseline findings and sex differences from the multicenter TEACH trial |
| title_fullStr | Identification and characteristics of distressed patients with coronary heart disease and insufficiently controlled medical risk factors: baseline findings and sex differences from the multicenter TEACH trial |
| title_full_unstemmed | Identification and characteristics of distressed patients with coronary heart disease and insufficiently controlled medical risk factors: baseline findings and sex differences from the multicenter TEACH trial |
| title_short | Identification and characteristics of distressed patients with coronary heart disease and insufficiently controlled medical risk factors: baseline findings and sex differences from the multicenter TEACH trial |
| title_sort | identification and characteristics of distressed patients with coronary heart disease and insufficiently controlled medical risk factors baseline findings and sex differences from the multicenter teach trial |
| topic | coronary heart disease cardiovascular risk factors psychological distress blended collaborative care sex differences |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1494839/full |
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