Healthcare Use in Patients With Cardiovascular Disease and Depressive Symptoms – The Impact of Internet-Delivered Cognitive Behavioural Therapy. A Secondary Analysis of a RCT

Background: Depressive symptoms in patients with cardiovascular disease (CVD) can lead to increased healthcare use and cause an economical burden for society. Thus, interventions aiming to decrease depressive symptoms in these patients could reduce the use of healthcare services. In a previous study we reported that a 9-week internet-delivered cognitive behavioural therapy (iCBT) program (n=72) compared to an online discussion forum (ODF) (n=72) had moderate to large effect on depression in CVD outpatients. However, the associations between healthcare use and depressive symptoms were not reported in that study. The aim of this study was to describe and compare the effect of iCBT compared to ODF regarding healthcare use and to identify factors impacting healthcare use in these groups. Methods: Secondary analysis of a RCT. Data on healthcare use (including outpatient clinic/primary care contacts and hospital admissions) were retrieved from care data registries in five hospitals in Southeastern Sweden. Patients were predominantly males in both groups with a mean age of 61±13 and 64±12 years in iCBT and ODF respectively. Results: The year before the intervention, the iCBT group had a mean of 31 outpatient contacts per patient compared with 21 contacts the year after. The corresponding numbers for the ODF group were 37 and 25. The decrease was 32% in both groups and did not differ significantly between the groups.Regarding hospital admissions, the iCBT group had 0.8 admissions per patient the year before and 0.6 the year after the intervention, i.e. a decrease by 25%, whereas the ODF group had 1.1 and 0.6 admissions respectively, i.e. a decrease by 45%. The difference was not significant between the groups.Improvement in depressive symptoms post intervention was significantly associated with a decrease in number of outpatient contacts in the iCBT group. In the ODF group, better mental health-related quality of life post intervention was significantly associated with a decrease in number of hospital admissions. Conclusions: Reduced depressive symptom scores following intervention were associated with lower outpatient service use, but iCBT was not superior compared to ODF in decreasing healthcare use. Trial registration The study was registered at ClinicalTrials.gov, NCT02778074.