International Study Targeting Integration Care for Cardiovascular Patients with Depression in China

On 21 October 2014, a multi-disciplinary and international study integrating depression care in “Acute Coronary Syndromes” (ACS) patients officially launched in Beijing. The study is named as “Integrating Depression Care in Acute Coronary Syndromes Patients in Low Resource Hospitals in China” (I-Care Study). 

More than 60 participants attended the launch and training, including Professor Yangfeng WU, the Principal Investigator of the study, Professorial Fellow at The George Institute for Global Health at Peking University Health Science Center, Executive Director of Peking University Clinical Research Institute, Professor Xin YU, Former President-elect of Chinese Society of Psychiatry, Former Director of Peking University Institute of Mental Health, and hospital presidents, Cardiovascular division directors, and researchers from 20 county-level hospitals nationwide.

Cardiovascular disease is the leading cause of death and disability in China and worldwide, seriously threatening the patients’ health. Many patients with cardiovascular diseases are also affected by psychological barriers, among which depression is the most common.  In fact, depression has been becoming common among population, bringing larger burden as well as challenge to chronic disease prevention and control.

Professor Yu said, “In China, the total number of individuals with various mental health disorders is assessed to be over 100 million. However, healthcare facilities providing mental health services are not common in China, including metropolis like Beijing or Shanghai. The situation in remote rural areas is even worse, with fewer or without healthcare facilities of such kind.

It is known that in developed countries, integrated care to patients with both mental illness and cardiovascular diseases is implemented, as well as depression screening and management. Yet the effectiveness of these approaches is still unclear. In China, low awareness, resource, and capacity prevent providing high-quality care to patients with both mental illness and cardiovascular diseases.

“This study aims to evaluate whether depression management and cardiovascular disease management can be cost-effectively provided and improve the health outcomes or not, in rural China”.

The research proposes approaches which are quite new to the healthcare service in China, in particular to low-resource hospitals lacking trained mental health specialists. The novel concept includes recruiting a nurse in the cardiology ward who can screen, diagnose and treat patients with acute coronary syndrome (ACS), one of the most life-threatening cardiovascular diseases, and depression. Providing online support to nurses from mental health experts broaden the access to mental healthcare services.  The re-construction of healthcare service model and workforce maximizes the efficiency of current resources, and will positively influence the prevention and control of cardiovascular diseases as well as the healthcare status in China.

A patient participating in the pilot study said he thought his rehabilitation benefited from this new healthcare model. “Effective communication and trust have been built between patients and the head nurse. Not only our own health and mental issues are addressed, we also learned to help our family members quit smoking, improve our sleeping quality. It is very useful, and I like this kind of activities very much.” The patient said.

The study will utilize the platform of the “Clinical Pathways for Acute Coronary Syndromes in China” (CPACS-3) study carried out by The George Institute for Global Health at Peking University Health Science Center, recruiting 4000 ACS patients from 20 county-level hospitals in 10 provinces and autonomous regions in China..

This study is funded by the US National Institute Of Mental Health of the National Institutes of Health (NIMH). Researchers and academics from The George Institute for Global Health in China, Australia and India, Peking University Institute of Mental Health, and Duke University participate in the study. We believe that this innovative, flexible and sustainable model can be applied to a variety of chronic conditions, leading to new approaches for cardiovascular disease prevention and control in China”, Professor WU said.