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Was bringt Patienten mit Herzinsuffizienz und Depression Vorteile?

von NFI Redaktion

In a recently published article in JAMA Network Open, researchers compared the effectiveness of antidepressant drug management (MEDS) with behavioral activation psychotherapy (BA) in inpatients admitted to a hospital with heart failure (HF) and ambulatory patients presenting to clinics for HF follow-up, both experiencing depressive symptoms.
They conducted a randomized controlled trial (RCT) between 2018 and 2022, including a one-year follow-up within the Cedars-Sinai Health System in California, USA.

Study: Comparative effectiveness of psychotherapy vs. antidepressants in depression in heart failure. Image Credit: New Africa/Shutterstock.com

Background

The interplay of biological and psychosocial mechanisms leads to depression in approximately 50% of HF survivors.
As a result, HF patients with depression have poorer health-related quality of life (HRQOL) compared to HF patients without depression.
The severity of the patient’s depressive symptoms also increases the risk of cognitive decline or death after six months; it is also an independent factor associated with overall mortality.
Accordingly, the American Heart Association (AHA) recommends screening for depression in HF patients and other cardiac diseases. However, providing treatments such as antidepressants and psychotherapy for diagnosed depression in HF patients is equally important, which is often not the case.
Some notable evidence-based treatments for depression in HF patients are cognitive behavior therapy (CBT), such as BA, and antidepressants, also known as pharmacotherapy. However, issues that require attention include restricted access to these interventions and a lack of evidence for clinicians on which intervention to use for treating depression in HF patients.

About the Study

The researchers addressed these challenges facing clinicians, patients, and caregivers in the present study and compared the effectiveness of psychotherapy with pharmacotherapy for patient-centered outcomes in an RCT.
The study cohort had a life expectancy of over six months after heart failure, confirmed by their treating physician, and a depressive disorder based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria.
The team randomly assigned participants in a 1:1 ratio to BA or MEDS. BA therapists, licensed clinical social workers, and MEDS care managers participated in a 50-minute introductory session with the participants, followed by 12 weekly BA or MEDS sessions. These sessions were conducted monthly for three months, followed by contacts for an additional six months, if deemed necessary. They conducted 50-minute BA and 15-minute MEDS sessions via phone/video call, which was easily accessible for HF patients, saved time, and improved program compliance; it also improved mood and quality of life without compromising efficacy.
This study yielded several interesting outcomes, with the severity of depressive symptoms after six months, measured using the Patient Health Questionnaire-9 (PHQ-9), being the primary outcome. Secondary outcomes included physical/mental HRQOL and HF-specific HRQOL, measured using the Short Form 12-Item Version 2 (SF-12) and the Kansas City Cardiomyopathy Questionnaire. The team also monitored caregiver burden, measured using the Caregiver Burden Questionnaire in Heart Failure; in addition, they recorded emergency room visits, readmissions, days of hospitalizations, and mortality at three, six, and twelve months.

Results

Of the 416 HF patients included in this RCT, 243 were male, and the average age of the study participants was 60.71 years.
Both the BA and MEDS groups included 208 patients, with average (SD) PHQ-9 values at study onset of 14.54 (3.45) and 14.31 (3.60), respectively.
Even after six months, their PHQ-9 values did not differ statistically (7.53 vs. 8.09; P = 0.88). Additionally, both BA and MEDS recipients experienced around a 50% reduction in depressive symptoms after three, six, and twelve months. The BA recipients showed less improvement in physical quality of life after six months than MEDS recipients (mean SF-12 physical score: 38.82 vs. 37.12; P = 0.04). Moreover, they had fewer emergency room visits and fewer days in the hospital at all three time points, all statistically significant observations. However, there was no significant difference in hospital readmissions for participants in the BA group compared to MEDA recipients. The authors attributed these differences to poor overall health status, a reliable risk factor associated with rehospitalization in HF patients with depression. It is also noteworthy that BA recipients were encouraged to be more physically active than MEDS recipients, which likely contributed to their tendency to have fewer emergency room visits and fewer hospital days.

Conclusions

Overall, the present RCT confirmed that both interventions, BA and MEDS, reduced depressive symptoms in HF patients with depression by almost 50%. Additionally, BA recipients experienced better physical quality of life, made fewer emergency room visits, and spent fewer days in the hospital. These data could inform clinicians and caregivers that they can choose both psychotherapy and pharmacotherapy to improve depressive symptoms in HF patients.

Journal reference:

  • Waguih WI, (2024), Comparative effectiveness of psychotherapy vs. antidepressants in depression in heart failure, a randomized clinical trial, JAMA Network Open. doi:10.1001/jamanetworkopen.2023.52094.

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