Behavioral Activation Delivered via Home-based Telehealth to Improve Functioning in Cardiovascular Disease Patients Recently Discharged from Inpatient Care

Background and Significance: Following hospital discharge, risk of depression is significantly increased in cardio-vascular disease (CVD) patients. Moreover, CVD patients with depression face reduced functioning, increased morbidity and mortality, and diminished quality of life. Unfortunately, most depressed CVD patients do not receive

appropriate evidence-based care for their depression, often because they are unable to, or fearful of travelling to providers for the regimen of 8-12 weekly visits of evidence-based psychotherapy such as Behavioral Activation (BA). Our group developed, evaluated and subsequently implemented in VA clinics, the first VA

program to use home based telehealth to deliver BA for depression to elderly Veterans. We now propose to evaluate the ability of this evidence based treatment and delivery model (BA for depression via home- telehealth) to reduce functional impairment and improve recovery in depressed Veterans who have

experienced a CVD event-related hospitalization. Research Plan and Specific Aims: 1. To compare effectiveness of Behavioral Activation for depression delivered via Home-based Telehealth- to standard post-CVD hospital discharge best-practices care in a 2x4 (treatment by time) repeated measures RCT crossover design (baseline, post-treatment, 3 & 9-month follow-up; crossover for standard

treatment group at 9 months) with 132 CVD Veteran patients evincing depression in terms of central outcomes of functioning (PROMIS Functioning and Global Health scales) and emotional symptoms (PROMIS Depression and Anxiety scales) and secondary objective outcomes related to activity (actigraphy data). At the 9 month

point, the comparison group will have the option of receiving the intervention (thus complementing the RCT with a crossover phase). 2. To repeat these comparisons with sex and age as independent variables. 3. To evaluate BA-HT with respect to its effects on exploratory outcomes, including re-hospitalization.

Hypotheses: We predict that evidence-based psychotherapy for depression (i.e., Behavioral Activation) delivered via home based telehealth will more effectively increase social role and activity functioning, activity, mood and reduce 6-month re-hospitalization (exploratory hypothesis), compared to current best-practices post-discharge

care among patients scoring at least moderately depressed on the PROMIS Depression scale one week following hospital discharge for a CVD event. Impact: If effective, this innovative treatment and delivery strategy will enhance global functioning, improve quality of life, and reduce costs to Veterans and the VA. Importantly, the proposed strategy leverages existing

VA infrastructure and capabilities so that BA-HT could be immediately offered throughout VA as a preventative measure to enhance resiliency.