Co-treatment of heart failure and depression improves quality of life
Principal investigator Bruce Rollman, M.D., M.P.H., UPMC Endowed Chair in General Internal Medicine at Pitt, received a five-year, $7.3 million grant from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health, to conduct the Hopeful Heart Trial, which enrolled 756 heart failure patients from several UPMC hospitals.
"Heart failure is the No. 1 cause of Medicare readmissions, and 40 to 70 percent of heart failure patients have co-morbid depression, meaning they are experiencing both conditions simultaneously," said Rollman, also the director of Pitt's Center for Behavioral Health and Smart Technology. "However, depression is often unrecognized and untreated in these patients, even by existing collaborative care programs for heart failure, so we designed our trial to gauge the impact of adding depression care on patients' quality of life, physical function, readmission and health care costs."
The Hopeful Heart study team screened hospitalized patients with systolic heart failure for depression and then re-contacted them two weeks after discharge home to rescreen them for the illness.
Participants who still met criteria for depression were randomized into three arms: doctors' usual care for these conditions; a nurse-provided collaborative care intervention that addressed only heart failure; or a similar, nurse-provided care intervention that addressed both depression and heart failure. The study also included a non-depressed comparison group of heart failure patients to provide a fuller picture of the impact of depression and its treatment.
At 12-months follow-up, Rollman and his team found that the blended model of care improved participants' mental health-related quality of life and mood symptoms compared to usual care, and the blended model also improved patients' mood symptoms significantly more than collaborative care for heart failure alone.
Although the researchers' initial analysis found that neither collaborative care method significantly reduced the rate of hospital readmissions or all-cause mortality among depressed heart failure patients, Rollman cautioned that additional analyses and longer follow-up are needed to confirm these findings.
"Overall, these results are a reminder for all clinicians, not just cardiologists, to be mindful of their patients' mental health, as elevated depressive symptoms occurred in nearly half of all hospitalized heart failure patients and persisted in over one-third at two weeks following discharge," said Rollman. "A quick screening or referral to a mental health professional could significantly impact that person's well-being, especially if that patient's cardiac symptoms are out of proportion to his or her objective disease burden."
Provided by University of Pittsburgh