Personalized treatments for depressive symptoms in patients with advanced heart failure: A pragmatic randomized controlled trial

IsHak, Waguih William; Korouri, Samuel; Darwish, Tarneem; Vanle, Brigitte; Dang, Jonathan; Edwards, Gabriel G; Black, Jeffrey D.; Aronow, Harriet Udin; Kimchi, Asher; Spiegel, Brennan M.; Hedrick, Rebecca; Chernoff, Robert A.; Diniz, Márcio A.; Mirocha, James; Manoukian, Vicki; Harold, John; Ong, Michael; Wells, Kenneth B.; Hamilton, Michèle A.; Danovitch, Itai

doi:10.1371/journal.pone.0244453

Cited by 3 publications

(5 citation statements)

References 59 publications

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“…Outro estudo recente, randomizado, realizado nos Estados Unidos, comparou a terapia comportamental, uma psicoterapia centrada no paciente, com acompanhamento regular dos pacientes, através da telemedicina, ao tratamento apenas com antidepressivos. Foi observado que ambos os tratamentos possuíam benefícios na qualidade de vida e na diminuição da mortalidade, porém a terapia comportamental teve maior impacto 23 .…”

Section: Discussionunclassified

Depressão em pacientes com insuficiência cardíaca descompensada

Nascimento,

Santos,

Bezerra

et al. 2023

Saúde e meio ambient.: rev. interdisciplin.

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Objetivo: Evidenciar a prevalência de depressão em pacientes com insuficiência cardíaca descompensada. Método: Trata-se de um estudo observacional, transversal, de abordagem quantitativa. Foram entrevistados 133 pacientes com diagnósticos de insuficiência cardíaca descompensada, por meio do Inventário de Depressão de Beck, obtendo os dados sociodemográficos através das entrevistas e consultas a prontuários pessoais. Para a análise quantitativa das variáveis entre os escores de depressão e os fatores sociodemográficos, utilizou-se o teste de qui-quadrado de Pearson. Resultados: O estudo evidenciou que a maioria dos entrevistados pontuaram para depressão mínima (42,1%) e quando comparados nível de depressão com as variáveis sociodemográficas e clínicas, houve significância com a condição econômica (p=0,002), presença de comorbidades, (p=0,036) e diagnóstico prévio de depressão (p=0,032). Conclusão: Foram encontrados dados significativos de sintomas depressivos em pacientes que não possuíam diagnóstico prévio de depressão, impulsionando a necessidade da detecção precoce e a implementação de ferramentas de rastreamento da doença nos pacientes com insuficiência cardíaca. Palavras-chave: Cardiopatia. Doença Psiquiátrica. Hospitalização.

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Section: Discussionunclassified

Depressão em pacientes com insuficiência cardíaca descompensada

Nascimento,

Santos,

Bezerra

et al. 2023

Saúde e meio ambient.: rev. interdisciplin.

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“…Based on our findings, the presence or increased intensity of depressive symptoms should be addressed early and be considered potential antecedents of physical symptoms and impact on QoL, especially in patients dependent for ADLs. Different clinical trials are currently being conducted to determine effective medication and non-pharmacological interventions for the treatment of depressive symptoms in this population (Ishak et al, 2021; Zhang et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Relationships between Depressive Symptoms, Appetite, and Quality of Life in Heart Failure

et al. 2022

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This analytical, cross-sectional study aimed to analyze the relationship between depressive symptoms, appetite, and quality of life (QoL) in 86 patients hospitalized with heart failure. Patients were assessed for depressive symptoms, appetite, and QoL using the Beck Depression Inventory-II, the Simplified Nutritional Appetite Questionnaire, and the Minnesota Living with Heart Failure Questionnaire, respectively. Relationships between sociodemographic and clinical variables, depressive symptoms, appetite, and QoL were analyzed using bivariate tests and linear regression models, with p < .05 considered significant. The factors associated with QoL were dependence for four activities of daily living (ADLs) (estimate = 15.4, 95% CI = 0.23 to 30.64, p = .046), minor depressive symptoms (estimate = –20.0, 95% CI = –28.3 to −11.73, p < .001), and appetite (estimate = –11.08, 95% CI = –20.5 to −1.62, p = .022). These results can support multi-professional assessment and development of interventions to promote better QoL, including addressing impaired appetite and food intake, the presence or increased intensity of depressive symptoms, especially in patients dependent for ADLs.

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“…This comparative effectiveness randomized clinical trial was approved by the Cedars-Sinai institutional review board. The trial protocol 18 and statistical analysis plan are available in Supplement 1 . All participants provided written informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…We conducted a randomized comparative effectiveness trial of 2 evidence-based treatments for depression in inpatients and outpatients with HF: BA vs MEDS. Our trial protocol 18 was developed in collaboration with an advisory group of clinicians (cardiologists, primary care physicians, psychiatrists, and psychotherapists), researchers, patients, caregivers, and patient advocates. Based on evaluation using the PRECIS-2 tool, 19 the study was performed in a pragmatic fashion, as detailed in eAppendix 1 in Supplement 2 .…”

Section: Methodsmentioning

confidence: 99%

“…In this context, we conducted a randomized trial to compare the efficacy of BA vs antidepressant medication management (MEDS) in patients with HF and depression. Outcomes of interest included depressive symptom severity, physical and mental HRQOL, HF-specific HRQOL, caregiver burden, morbidity (as measured by ED visits, hospital readmissions, and days hospitalized), and mortality at 3, 6, and 12 months . We hypothesized that BA would be superior to MEDS on both primary and secondary outcomes, as suggested by previous research and given its lack of contribution to medication burden.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure

IsHak,

Hamilton,

Korouri

et al. 2024

JAMA Netw Open

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ImportanceHeart failure (HF) affects more than 6 million adults in the US and more than 64 million adults worldwide, with 50% prevalence of depression. Patients and clinicians lack information on which interventions are more effective for depression in HF.ObjectiveTo compare the effectiveness of behavioral activation psychotherapy (BA) vs antidepressant medication management (MEDS) on patient-centered outcomes inpatients with HF and depression.Design, Setting, and ParticipantsThis pragmatic randomized comparative effectiveness trial was conducted from 2018 to 2022, including 1-year follow-up, at a not-for-profit academic health system serving more than 2 million people from diverse demographic, socioeconomic, cultural, and geographic backgrounds. Participant included inpatients and outpatients diagnosed with HF and depression, and data were analyzed as intention-to-treat. Data were analyzed from 2022 to 2023.InterventionsBA is an evidence-based manualized treatment for depression, promoting engagement in personalized pleasurable activities selected by patients. MEDS involves the use of an evidence-based collaborative care model with care managers providing coordination with patients, psychiatrists, and primary care physicians to only administer medications.Main Outcomes and MeasuresThe primary outcome was depressive symptom severity at 6 months, measured using the Patient Health Questionnaire 9-Item (PHQ-9). Secondary outcomes included physical and mental health-related quality of life (HRQOL), measured using the Short-Form 12-Item version 2 (SF-12); heart failure-specific HRQOL, measured using the Kansas City Cardiomyopathy Questionnaire; caregiver burden, measured with the Caregiver Burden Questionnaire for Heart Failure; emergency department visits; readmissions; days hospitalized; and mortality at 3, 6, and 12 months.ResultsA total of 416 patients (mean [SD] age, 60.71 [15.61] years; 243 [58.41%] male) were enrolled, with 208 patients randomized to BA and 208 patients randomized to MEDS. At baseline, mean (SD) PHQ-9 scores were 14.54 (3.45) in the BA group and 14.31 (3.60) in the MEDS group; both BA and MEDS recipients experienced nearly 50% reduction in depressive symptoms at 3, 6, and 12 months (eg, mean [SD] score at 12 months: BA, 7.62 (5.73); P &lt; .001; MEDS, 7.98 (6.06); P &lt; .001; between-group P = .55). There was no statistically significant difference between BA and MEDS in the primary outcome of PHQ-9 at 6 months (mean [SD] score, 7.53 [5.74] vs 8.09 [6.06]; P = .88). BA recipients, compared with MEDS recipients, experienced small improvement in physical HRQOL at 6 months (mean [SD] SF-12 physical score: 38.82 [11.09] vs 37.12 [10.99]; P = .04), had fewer ED visits (3 months: 38% [95% CI, 14%-55%] reduction; P = .005; 6 months: 30% [95% CI, 14%-40%] reduction; P = .008; 12 months: 27% [95% CI, 15%-38%] reduction; P = .001), and spent fewer days hospitalized (3 months: 17% [95% CI, 8%-25%] reduction; P = .002; 6 months: 19% [95% CI, 13%-25%] reduction; P = .005; 12 months: 36% [95% CI, 32%-40%] reduction; P = .001).Conclusions and RelevanceIn this comparative effectiveness trial of BA and MEDS in patients with HF experiencing depression, both treatments significantly reduced depressive symptoms by nearly 50% with no statistically significant differences between treatments. BA recipients experienced better physical HRQOL, fewer ED visits, and fewer days hospitalized. The study findings suggested that patients with HF could be given the choice between BA or MEDS to ameliorate depression.Trial RegistrationClinicalTrials.gov Identifier: NCT03688100.

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Personalized treatments for depressive symptoms in patients with advanced heart failure: A pragmatic randomized controlled trial

Cited by 3 publications

References 59 publications

Depressão em pacientes com insuficiência cardíaca descompensada

Depressão em pacientes com insuficiência cardíaca descompensada

Relationships between Depressive Symptoms, Appetite, and Quality of Life in Heart Failure

Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure

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