Effects of cognitive behavioural therapy for depression in heart failure patients: a systematic review and meta-analysis

Abstract

This systematic review and meta-analysis aimed to evaluate the effects of cognitive behavioural therapy (CBT) on depression, quality of life, hospitalisations and mortality in heart failure patients. The search strategy was developed for Ovid MEDLINE and modified accordingly to search the following bibliographic databases: PubMed, EMBASE, PsycINFO, CENTRAL and CINAHL. Databases were searched from inception to 6 March 2016 for randomised controlled trials (RCTs) or observational studies that used CBT in heart failure patients with depression or depressive symptoms. Six studies were identified: 5 RCTs and 1 observational study, comprising 320 participants with predominantly NYHA classes II-III, who were mostly male, with mean age ranging from 55 to 66 years. Compared to usual care, CBT was associated with a greater improvement in depression scores both initially after CBT sessions (standardised mean difference −0.34, 95% CI −0.60 to −0.08, p = 0.01) and at 3 months follow-up (standardised mean difference −0.32, 95% CI −0.59 to −0.04, p = 0.03). Greater improvement in quality of life scores was evident for the CBT group initially after CBT sessions, but with no difference at 3 months. Hospital admissions and mortality were similar, regardless of treatment group. CBT may be more effective than usual care at improving depression scores and quality of life for heart failure patients initially following CBT and for depression at 3 months. Larger and more robust RCTs are needed to evaluate the long-term clinical effects of CBT in heart failure patients.Electronic supplementary materialThe online version of this article (doi:10.1007/s10741-017-9640-5) contains supplementary material, which is available to authorized users.

Heart and brain interaction in patients with heart failure: overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association

“…Treatment of depression with antidepressants in HF has not been very encouraging and the results of two major randomized trials (SADHART‐CHF and MOOD‐HF) did not show significant improvement in depression scores and HF outcomes with the use of selective serotonin re‐uptake inhibitors. Short‐term psychotherapeutic treatments like exercise training and cognitive behavioural therapy are safe and improve depression scores in meta‐analyses of randomized controlled trials, but their sustainability in long‐term clinical practice is unknown . Electroconvulsive therapy is considered to be safe, but cardiac complications (hypertension and arrhythmias) may occur even with a ‘cardiac‐modified’ protocol .…”

“…Short-term psychotherapeutic treatments like exercise training and cognitive behavioural therapy are safe and improve depression scores in meta-analyses of randomized controlled trials, but their sustainability in long-term clinical practice is unknown. 71,72 Electroconvulsive therapy is considered to be safe, but cardiac complications (hypertension and arrhythmias) may occur even with a 'cardiac-modified' protocol. 73 Currently, the combination of cognitive behavioural therapy with a selective serotonin re-uptake inhibitor is the preferred management of depression in a HF patient.…”

Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

“…In a recent systematic review and meta-analysis [169], a CBT intervention on depression, quality of life, hospitalizations and mortality in CHF patients was associated with a greater improvement, compared to usual care, in depression scores both at the end of the CBT program and 3 months later. Greater improvement in quality of life scores was evident for the CBT group initially after CBT sessions, but there was no difference at 3 months.…”

Behind the Screen: –Internet-Based Cognitive Behavioural Therapy to Treat Depressive Symptoms in Persons with Heart Failure

“…This effect is also reported in studies of ICBT for somatic diseases [100] In the context of persons with coexisting somatic chronic disease and depressive symptoms, studies suggest that unguided generic ICBT programs for depression have a disadvantage in that they are not adapted for the complex situation of suffering from both somatic disease and depressive symptoms [113,114], suggesting that adapted ICBT programs for those with somatic diseases may be warranted. However, there are only a few studies that have investigated the effect of CBT on depression in persons with heart failure [115].…”

“…This because traditional first line pharmacological treatment appears less effective [74,75] and a large treatment-demand gap has appeared due to a lack of psychotherapists [95]. As described in table 2 and in a recent meta-analysis [115] CBT has demonstrated promising results regarding depression for persons with heart failure. However, faceto-face CBT is resource-demanding, and less resource-demanding modalities of CBT, such as ICBT, have not been adapted and tested in persons with depressive symptoms and heart failure.…”