Blended treatment for depression, heart failure improves quality of life
NEW ORLEANS — Care composed of treating depression and HF may improve health-related quality of life in the 12 months after hospitalization, according to Hopeful Heart trial findings presented at the American College of Cardiology Scientific Session.
Bruce L. Rollman, MD, MPH, professor of medicine, psychiatry, biomedical informatics and clinical and transitional science at the University of Pittsburgh School of Medicine, and colleagues sought to evaluate the effect of a collaborative care program for depression in patients with HF.
“Heart failure is super common in the United States and worldwide,” Rollman said during the presentation. “There’s been a number of studies that show that depression is highly comorbid in hospitalized heart failure patients and is also associated with decreased health-related quality of life, decreased adherence with evidence-based care, increased mortality, readmissions and health care costs.”
The researchers analyzed data from the Patient Health Questionnaire (PHQ-2) between March 2014 and October 2017 to screen inpatients with HF with reduced ejection fraction — 45% or lower — and NYHA class II to IV symptoms of depression in eight Pittsburgh hospitals.
Rollman and colleagues conducted telephone screenings 2 weeks after discharge to administer another questionnaire, PHQ-9.
Patients who scored 10 or more were randomly assigned to their primary care provider’s usual care or to one of two 12-month collaborative care programs — blended or usual care. Blended care consisted of treatment for HF and depression. The usual-care collaborative care program (enhanced usual care) focused on HF treatment only.
The study included 756 patients with HF (629 with depression; mean age, 64 years; 56% men; 73% white; mean EF, 28%).
The patients with depression had worse health-related quality of life vs. patients without depression based on an SF-12 mental component score (mean, 40.1 vs. 60.5; P < .001), according to the researchers. Patients with depression also had worse physical function based on the Kansas City Cardiomyopathy Questionnaire-12 (40.4 vs. 76.8; P < .001) and mood based on the Hamilton Rating Scale for Depression (16.8 vs. 2; P < .001) compared with patients without depression.
At 12 months, blended care patients had an improvement on the SF-12 mental component score compared with usual care (P = .002).
PROMIS depression score was also better at 12 months in the blended care group compared with the usual care (P < .0001) or enhanced usual care (P = .006) groups, according to the researchers.
All-cause readmissions did not differ between the groups at 12 months (P = .49), nor did they significantly differ between patients who were depressed and patients who were not depressed (P = .22), though the depressed patients had a 90% rate compared with a 75% rate for non-depressed patients, Rollman said.
In addition, 12-month all-cause mortality did not significantly differ between the care groups (P = .79) or between depressed and non-depressed patients (P = .32), he said, but noted the rate was numerically higher in depressed patients (14.5% vs. 10.5%).
“If I had to put this on a bumper sticker, it’s ‘depression kills,’” Rollman said during the presentation. “Please do recognize that we see this in our study, and we see this in many other studies too that comorbid depression approximately doubles the mortality risk. In our case, about 40% to 45%. It is important for cardiologists to recognize that.” – by Earl Holland Jr.
Rollman B, et al. Featured Clinical Research I. Presented at: American College of Cardiology Scientific Session; March 16-18, 2019; New Orleans.
Disclosure: Rollman reports no relevant financial disclosures.