Background
Depressed mood, psychiatric, depressed, depression, ACS
CARDIAC EVENTS, UNSTABLE ANGINA, ACUTE CORONARY SYNDROME
1.2 million individuals survive acute coronary syndrome (ACS; unstable angina, ST and non-ST elevation myocardial infarction) in the US each year Depressed mood is a major concern in ACS patients. Clinical depression and sub-clinical depression symptoms are much more common in ACS patients than the general population Smokers are more likely to be depressed at the time of ACS and to experience onset of depression post-ACS than people without a smoking history Behavioral Activation (BA) is a counseling intervention with clearly established efficacy for the treatment and prevention of depression in both psychiatric and medical populations Our team used a series of semi-structured interviews and test cases to systematically develop an intervention integrating gold standard smoking cessation counseling with existing BA based mood management techniques for post-ACS smokers; Behavioral Activation Treatment for Cardiac Smokers (BAT-CS) A fully powered efficacy trial is underway which will enroll 324 daily smokers with ACS. Patients are randomized to 12 weeks of BAT-CS or a control group where counselors provide the same smoking cessation content plus health education content as a contact control for time spent on BA techniques. Both groups are offered the nicotine patch if medically safe. Follow-up assessments are conducted at end-of-treatment (12-weeks) and 6, 9, and 12 months after hospital discharge. We are tracking the occurrence of major adverse cardiac events and all-cause mortality for 36 months post discharge.The primary aims and hypotheses of this study are: