FROM JAMA INTERNAL MEDICINE
Cognitive behavioral therapy significantly improved major depression but did not improve self-care by heart failure patients, investigators reported online in JAMA Internal Medicine.
“The results suggest that CBT is superior to usual care for depression in patients with heart failure,” said Dr. Kenneth Freedland and his associates at Washington University in St. Louis. They called the findings “especially encouraging” in light of recent negative results from the SADHART-CHF and MOOD-HF trials of selective serotonin reuptake inhibitors in this population.Patients in heart failure often have major depression, which increases their chances of poor self-care, hospitalization, and mortality, the researchers noted. Their single-blind, randomized trial included 158 patients who were in New York Heart Association class I, II, or III heart failure and met criteria for major depression. Patients in the intervention group received standard medical care, plus up to 6 months of CBT designed for cardiac patients.Patients received CBT weekly, then biweekly, and then monthly as they reached their treatment goals, but they also received telephone follow-up to help prevent relapse. The control group received standard medical care plus consultation with a cardiac nurse, written materials on heart failure self-care, and three follow-up phone calls with the nurse (JAMA Intern Med. 2015 Sept. 28. doi: 10.1001/jamainternmed.2015.5220 ). At 6 months, the CBT group scored significantly lower on the BDI-II than did controls (mean score, 12.8 [standard deviation, 10.6] vs. 17.3 [10.7]; P = .008), the researchers said. Remission rates with CBT were 46% based on the BDI-II and 51% based on the Hamilton Depression Scale, both of which significantly exceeded remission rates of 19-20% for controls. The CBT group also improved significantly more than did controls on standard measures for anxiety, heart failure-related quality of life, mental health–related quality of life, fatigue, and social functioning, but not on measures of physical functioning, the researchers reported.
The National Heart, Lung, and Blood Institute partially funded the study. The researchers declared no competing interests.
