Efficacy of Blended Collaborative Care for Patients With Heart Failure and Comorbid Depression

Abstract

IMPORTANCE Depression is often comorbid in patients with heart failure (HF) and is associated with worse clinical outcomes. However, depression generally goes unrecognized and untreated in this population.OBJECTIVE To determine whether a blended collaborative care program for treating both HF and depression can improve clinical outcomes more than collaborative care for HF only and physicians' usual care (UC). DESIGN, SETTING, AND PARTICIPANTSThis 3-arm, single-blind, randomized effectiveness trial recruited 756 participants with HF with reduced left ventricular ejection fraction (<45%) from 8 university-based and community hospitals in southwestern Pennsylvania between March 2014 and October 2017 and observed them until November 2018. Participants included 629 who screened positive for depression during hospitalization and 2 weeks postdischarge and 127 randomly sampled participants without depression to facilitate further comparisons. Key analyses were performed November 2018 to March 2019. INTERVENTIONS Separate physician-supervised nurse teams provided either 12 months of collaborative care for HF and depression ("blended" care) or collaborative care for HF only (enhanced UC [eUC]). MAIN OUTCOMES AND MEASURES The primary outcome was mental health-related quality of life (mHRQOL) as measured by the Mental Component Summary of the 12-item Short Form Health Survey (MCS-12). Secondary outcomes included mood, physical function, HF pharmacotherapy use, rehospitalizations, and mortality. RESULTS Of the 756 participants (mean [SD] age, 64.0 [13.0] years; 425 [56%] male), those with depression reported worse mHRQOL, mood, and physical function but were otherwise similar to those without depression (eg, mean left ventricular ejection fraction, 28%). At 12 months, blended care participants reported a 4.47-point improvement on the MCS-12 vs UC (95% CI, 1.65 to 7.28; P = .002), but similar scores as the eUC arm (1.12; 95% CI, −1.15 to 3.40; P = .33). Blended care participants also reported better mood than UC participants (Patient-Reported Outcomes Measurement Information System-Depression effect size, 0.47; 95% CI, 0.28 to 0.67) and eUC participants (0.24; 95% CI, 0.07 to 0.41), but physical function, HF pharmacotherapy use, rehospitalizations, and mortality were similar by both baseline depression and randomization status. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial of patients with HF and depression, telephone-delivered blended collaborative care produced modest improvements in mHRQOL, the primary outcome, on the MCS-12 vs UC but not eUC. Although blended care did not differentially affect rehospitalization and mortality, it improved mood better than eUC and UC and thus may enable organized health care systems to provide effective first-line depression care to medically complex patients.

Progress in health-related behavioral intervention research: Making it, measuring it, and meaning it.

“…Research is also needed to evaluate how stepwise approach compare with—or fit into—other models of care. Stepped care has received less attention in the behavioral medicine and mental health research and practice communities than collaborative care (e.g., Bekelman et al, 2018; Carney et al, 2016; Huffman et al, 2014; Katon et al, 2010; Rollman et al, 2009, 2017, 2018, 2021), integrated care (Bartels et al, 2018; Baxter et al, 2018; Leung et al, 2019), and multidisciplinary precision medicine (Boland et al, 2019; Chen et al, 2018; Cuijpers et al, 2016; Lenze et al, 2020). However, these approaches may be compatible with stepped care; in fact, hybrid combinations of stepped care and other models of care have already been tested (e.g., Edmond et al, 2018; Horne et al, 2020; Huffman et al, 2014; Richards, 2012; Rollman et al, 2009, 2017, 2021).…”

Mechanism of tonifying-kidney Chinese herbal medicine in the treatment of chronic heart failure

“…Due to negative feedback, the expression and activity of mineralocorticoid receptor (MR) increased instead ( 105 ). Moreover, it is worth noting that chronic heart failure patients based on NYHA classes III and IV have a higher proportion of hypothermia ( 106 , 107 ), anorexia ( 108 , 109 ), depression ( 110 , 111 ), and a poor prognosis, which is similar to the phenomenon of kidney-Yang deficiency of TCM ( 112 ) or a lower response of ACTH and cortisol ( 102 , 113 ). Many classic prescriptions for warming and nourishing kidney-Yang, such as Sini decoction reverses hypothermia and balances hypothalamic-pituitary-adrenal axis in vivo ( 114 – 117 ) and improve chronic heart failure ( 38 , 114 , 118 ) ( Figure 3 ).…”

Leveraging Mobile Health to Manage Mental Health/Behavioral Health Disorders: Systematic Literature Review

“…Following the PRISMA checklist [20] and the Kruse protocol [21], we extracted the following data fields: participants, intervention, comparison with the control or other group, medical outcomes, and study design (PICOS; Table 1) as a way to summarize study characteristics, as required by PRISMA. Of the 33 studies analyzed over the 1-year period, 17 were from 2021 [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and 16 were from 2022 [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. All studies were RCTs involving adults, and 48% (16/33) involved an average age of 50 years or above.…”