ObjectiveThe purpose of this systematic review and meta-analysis was to evaluate the ability of psychosocial interventions to reduce depression and anxiety, improve quality of life, and reduce hospitalization and mortality rates in patients with heart failure.MethodsStudies of psychosocial interventions published from 1970 to 2021 were identified through four databases (PubMed, Ovid MEDLINE, PsycINFO, Cochrane). Two authors independently conducted a focused analysis and reached a final consensus on the studies to include, followed by a quality check by a third author. A risk of bias assessment was conducted.ResultsTwenty-three studies were identified, but only 15 studies of mostly randomized controlled trials with a total of 1370 patients with heart failure were included in the meta-analysis. Interventions were either cognitive behavioral therapy (CBT) or stress management. The pooled intervention effect was in favor of the intervention for depression (combined difference in standardized mean change [DSMC]: −0.41; 95% confidence interval [CI] = −0.66 to −0.17; p = .001) and anxiety (combined DSMC: −0.33; 95% CI = −0.51 to −0.15; p < .001) but was only a trend for quality of life (combined DSMC: 0.14; 95% CI = −0.00 to 0.29; p = .053). Evidence was limited that interventions produced lower rates of hospitalization (5 of 5 studies showing a beneficial effect) or death (1 of 5 with a beneficial effect).ConclusionsCBT and stress management interventions significantly reduced depression and anxiety compared with control conditions. CBT significantly improved quality of life compared with controls, but stress management did not. Longer treatment duration seemed to be an important factor related to treatment success.

Background People with opioid use disorder experience high burden of disease from medical comorbidities and are increasingly hospitalized with medical complications. Medications for opioid use disorder are an effective, life-saving treatment, but patients with an opioid use disorder admitted to the hospital seldom initiate medication for their disorder while in the hospital, nor are they linked with outpatient treatment after discharge. The inpatient stay, when patients may be more receptive to improving their health and reducing substance use, offers an opportunity to discuss opioid use disorder and facilitate medication initiation and linkage to treatment after discharge. An addiction-focus consultative team that uses evidence-based tools and resources could address barriers, such as the need for the primary medical team to focus on the primary health problem and lack of time and expertise, that prevent primary medical teams from addressing substance use. Methods This study is a pragmatic randomized controlled trial that will evaluate whether a consultative team, called the Substance Use Treatment and Recovery Team (START), increases initiation of any US Food and Drug Administration approved medication for opioid use disorder (buprenorphine, methadone, naltrexone) during the hospital stay and increases linkage to treatment after discharge compared to patients receiving usual care. The study is being conducted at three geographically distinct academic hospitals. Patients are randomly assigned within each hospital to receive the START intervention or usual care. Primary study outcomes are initiation of medication for opioid use disorder in the hospital and linkage to medication or other opioid use disorder treatment after discharge. Outcomes are assessed through participant interviews at baseline and 1 month after discharge and data from hospital and outpatient medical records. Discussion The START intervention offers a compelling model to improve care for hospitalized patients with opioid use disorder. The study could also advance translational science by identifying an effective and generalizable approach to treating not only opioid use disorder, but also other substance use disorders and behavioral health conditions. Trial registration: Clinicaltrials.gov: NCT05086796, Registered on 10/21/2021. https://www.clinicaltrials.gov/ct2/results?recrs=ab&cond=&term=NCT05086796&cntry=&state=&city=&dist =

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