Background Patients with heart failure (HF) experience depressive symptoms which contribute to poorer outcomes. We tested the effects of a brief cognitive therapy intervention on depressive symptoms, negative thinking, health-related quality of life, and cardiac event-free survival. Methods and Results Hospitalized patients with depressive symptoms (N=41, 66±11 yrs, 45% female, 81% NYHA Class III/IV) were randomly assigned to control group or a brief, nurse-delivered cognitive therapy intervention, delivered during hospitalization and followed by a one week booster phone call. Depressive symptoms, negative thinking and health-related quality of life were measured at one week and three months. Cardiac event-free survival was assessed at three months. Mixed models repeated measures ANOVA, Kaplan-Meier, and Cox regression were used for data analysis. Results There were significant improvements in depressive symptoms and health-related quality of life in both groups but no interactions between group and time. The control group had shorter three-month cardiac event-free survival (40% vs 80%, p<.05) and a 3.5 greater hazard of experiencing a cardiac event (p=.04) than the intervention group. Conclusion Nurses can deliver a brief intervention to hospitalized patients with HF that may improve short-term event-free survival. Future research is needed to verify these results with a larger sample size.

This systematic review and meta-analysis aimed to evaluate the effects of cognitive behavioural therapy (CBT) on depression, quality of life, hospitalisations and mortality in heart failure patients. The search strategy was developed for Ovid MEDLINE and modified accordingly to search the following bibliographic databases: PubMed, EMBASE, PsycINFO, CENTRAL and CINAHL. Databases were searched from inception to 6 March 2016 for randomised controlled trials (RCTs) or observational studies that used CBT in heart failure patients with depression or depressive symptoms. Six studies were identified: 5 RCTs and 1 observational study, comprising 320 participants with predominantly NYHA classes II-III, who were mostly male, with mean age ranging from 55 to 66 years. Compared to usual care, CBT was associated with a greater improvement in depression scores both initially after CBT sessions (standardised mean difference −0.34, 95% CI −0.60 to −0.08, p = 0.01) and at 3 months follow-up (standardised mean difference −0.32, 95% CI −0.59 to −0.04, p = 0.03). Greater improvement in quality of life scores was evident for the CBT group initially after CBT sessions, but with no difference at 3 months. Hospital admissions and mortality were similar, regardless of treatment group. CBT may be more effective than usual care at improving depression scores and quality of life for heart failure patients initially following CBT and for depression at 3 months. Larger and more robust RCTs are needed to evaluate the long-term clinical effects of CBT in heart failure patients.Electronic supplementary materialThe online version of this article (doi:10.1007/s10741-017-9640-5) contains supplementary material, which is available to authorized users.

Background Prognosis is worse in unmarried patients compared to married patients with heart failure (HF). The reasons for differences in outcomes are unclear, but variations in medication adherence may play a role, as medication adherence is essential to achieving better outcomes. Objective To determine whether medication adherence mediated the relationship between marital status and cardiac event-free survival in patients with HF. Method Demographic, clinical and psychosocial data were collected by questionnaires and medical record review for 136 HF patients (61 ± 11, 70% male, 60% NYHA III/IV). Medication adherence was monitored objectively for 3 months using the Medication Event Monitoring System. Cardiac event-free survival data were obtained by patient/family interview, hospital data base and death certificate review. A series of regression and Cox-survival analyses were performed to determine whether medication adherence mediated the relationship between marital status and event-free survival. Results Cardiac event-free survival was worse in unmarried patients than married patients. Unmarried patients were more likely to be nonadherent and were 2 times more likely to experience an event than married patients (p = .017). Marital status was not a significant predictor of event-free survival after entering medication adherence in the model, demonstrating a mediation effect of adherence on the relationship of marital status to survival. Conclusion Medication adherence mediated the relationship between marital status and event-free survival. It is important to design interventions to increase medication adherence that take into account subgroups, such as unmarried patients, who are at higher risk for nonadherence.

Background Patients with heart failure often experience depressive symptoms that affect health-related quality of life, morbidity, and mortality. Researchers have not described the experience of patients with heart failure living with depressive symptoms. Understanding this experience will help in developing interventions to decrease depressive symptoms.Objective To describe the experience of patients with heart failure living with depressive symptoms.Methods This study was conducted by using a qualitative descriptive design. The sample consisted of 10 outpatients (50% female, mean age 63 [SD, 13] years, 70% New York Heart Association class III or IV) with heart failure who were able to describe depressive symptoms. Data were collected via taped, individual, 30- to 60-minute interviews. ATLAS ti (version 5) was used for content analysis.Results Participants described emotional and somatic symptoms of depression. Negative thinking was present in all participants and reinforced their depressed mood. The participants experienced multiple stressors that worsened depressive symptoms. The overarching strategy for managing depressive symptoms was “taking my mind off of it.” Patients managed depressive symptoms by engaging in activities such as exercise and reading, and by using positive thinking, spirituality, and social support.Conclusions Patients with heart failure experience symptoms of depression that are similar to those experienced by the general population. Clinicians should assess patients with heart failure for stressors that worsen depressive symptoms. Strategies that researchers and clinicians can use to reduce depressive symptoms in patients with heart failure include engaging patients in activities, positive thinking, and spirituality. Helping patients find enhanced social support may also be important.

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