Behavioral Activation Delivered via Home-based Telehealth to Improve Functioning inCardiovascular 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.

Grant Number: 5I01RX003377-05
NIH Institute/Center: VA
Principal Investigator: Ronald Acierno