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HOPEFUL HEART: Joint effort to improve depressive symptoms in HF patients

Audrey Abella
27 Mar 2019
Dr Bruce Rollman discussing the results of the Hopeful Heart trial.

A telephone-delivered, nurse-provided, ‘blended’ collaborative care (CC) programme was better than usual care (UC) in improving health-related quality of life (HRQoL) and mood symptoms in patients with heart failure (HF) and comorbid depression, according to the results of the HOPEFUL HEART* trial presented at ACC.19.

This proactive approach integrated nurse care managers who called patients at regular intervals, as well as a cardiologist, an internist, and a mental health specialist for weekly case review meetings and follow-ups, said study author Professor Bruce Rollman from the University of Pittsburgh in Pittsburgh, Pennsylvania, US.

Medically stable patients with recent hospitalization for HF (mean age 65 years, 56 percent male) and depression (ie, Patient Health Questionnaire (PHQ)-2 positive [inpatient], PHQ-9 ≥10 [2 weeks following discharge]) were randomized to either the blended CC approach for both HF and depression (n=251), CC for HF alone (n=252), or UC for HF and depression (n=126). Those without depression (ie, PHQ-2 negative, PHQ-9 <5) comprised the control group (n=127). [ACC 2019, abstract 402-12]

At baseline, depressed patients had worse QoL (PHQ-9, 14 vs 2; PROMIS-D**, 60 vs 42; SF-12 MCS***, 40 vs 60; and SF-12 PCS#, 29 vs 38; p<0.0001 for all) and cardiac functioning (KCCQ-12##, 29 vs 38; p<0.0001 and New York Heart Association Class III/IV, 66 percent vs 42 percent; p=0.001) than nondepressed patients.

At 12 months, blended CC led to improved mental HRQoL (SF-12 MCS, effect size [ES], 0.34, 95 percent confidence interval [CI], 0.13–0.56; p=0.002) and mood symptoms (PROMIS-D, ES, 0.47, 95 percent CI, 0.28–0.67; p<0.0001) compared with UC.

However, after adjusting for confounders, patients with depression had numerically higher 1-year all-cause readmissions (90 percent vs 75 percent; p=0.22) and mortality (14.5 percent vs 10.5 percent; p=0.32) compared with nondepressed patients, highlighting the need for more effective treatments for depression, said Rollman.

Depression is highly comorbid with HF and associated with worse self-reported function and HRQoL,” said Rollman. Unfortunately, depression is generally unrecognized and untreated by cardiologists and primary care physicians, and there are hardly any trials assessing the impact of treating depression in patients with HF. [Curr Heart Fail Rep 2018;15:398-410]

Although the findings concur with previous evidence showing improved function, restored state of health, and reduced costs when patients were screened and treated for depression following bypass surgery, [JAMA 2009;302:2095-2103; Gen Hosp Psychiatry 2014;36:453-459] larger trials with longer follow-up periods remain warranted to validate the findings and evaluate readmission and mortality rates, he added.

While it was unclear why the patients’ QoL improved with the regular phone calls, Rollman pointed out that cardiac patients with mood symptoms usually report more symptoms, hence the importance of following up and screening for depression.

Whether depression is the cause of symptoms and mood change or vice versa is not the issue, Rollman added. “[The goal is to] make patients feel better … [and do] what we can to improve their lives,” he concluded.

 

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