a special program of the National Emergency Medicine Association (NEMA)
Week: 553.1 Guest: Dr. James Blumenthal, Prof. Psychology, Duke Univ. Med. Ctr. Topic: National study on psychological support for heart attack patients Producer/Host: Steve Girard
NEMA: About 13 million Americans have coronary artery disease...and up to one third of the one and a half million who suffer heart attacks each year die...many die during the recovery period from complications or another heart attack. We're with Dr. James Blumenthal, Professor of Medical Psychology at Duke University Medical Center..talking about a huge new study funded by the National Institutes of Health, aimed at treating patients who have had an acute heart attack with a psychological intervention...it's called ENRICHD, or Enhancing Recovery in Coronary Heart Disease Patients. Dr. Blumenthal, what did preliminary studies show....
BLUMENTHAL: Some were conducted at Duke University, others were conducted at other institutions around the country. And the evidence basically found that people who are depressed, or are socially isolated have increased risk of dying or having further heart complications after their initial heart attack...the thinking is that by treating social isolation and depression, we could potentially reduce the risk of these future adverse events.
NEMA: What are the numbers...what did the studies show was the range of increased risk?
BLUMENTHAL: The data are varied...anywhere from two to as much as six fold greater risk of dying or having a second or repeat heart attack... depending upon the study and the nature of the population, and the length of follow-up.
NEMA: How quickly should the intervention take place?
BLUMENTHAL: As quickly as possible, since we know the first several months are most critical, where patients are most vulnerable and at the highest risk.
NEMA: Many institutions are involved in this new study....Yale and Harvard, Washington University in St..Louis, University of Washington in Seattle, Stanford University, the University of Alabama at Birmingham, and the University of Miami, in Florida. ...and Rush Hospital in Chicago. And the University of North Carolina is the coordinating center....
BLUMENTHAL: Well, this is a study that will require 3000 patients, that will be recruited over a three year period...recruited and treated. The basic design is half patients get a psychological intervention, and the other half get routine care.And again, these patients are patients who have suffered an acute myocardial infarction...and who are at increased psycho-social risk by virtue of either being depressed or socially isolated. The treatment itself will last for six months of active psycho-social intervention...a standard cognitive behavioral therapy that will be performed individually and, when indicated, in groups....and it could be extended up to a year, if the condition warrants that , and then they'll be followed for at least an additional year - some patients will be followed for up to three years. This isn't an experimental protocol. For some patients who need medication, in combination with more traditional psychological intervention, we will provide that. So, we do have a non-experimental study mediation that we would administer to those patients for whom it is indicated.
NEMA: I understand there is a particularly imposing element to the recruitment....
BLUMENTHAL: The other feature of this study, which makes it particularly challenging, is that we are striving to recruit 50% women, 50% minorities...these populations have not typically been enrolled in most large scale clinical trials, so that's a major challenge for us and something that all the investigators are very active and aggressively attempting to fulfill these criteria.
NEMA: It's low tech...but it may be that psychological intervention immediately after a heart attack could save lives...and save a lot of health care dollars, too. The recruitment for the study began last month. Thanks to Dr. James Blumenthal of Duke University Medical Center. I'm Steve Girard.