Can treating depression in patients with heart failure help them live longer? That's one of the questions that University of Pittsburgh researchers hope to answer with a new five-year, $7.3 million grant from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health (NIH).
Nearly 6 million Americans live with heart failure, according to government estimates, and studies confirm about a quarter of them suffer from depression.
"Evidence-based depression treatments clearly improve health-related quality of life, yet it is presently unknown whether they also reduce morbidity and mortality, particularly in patients with cardiovascular disease. The Hopeful Heart trial will help us find out," said principal investigator Bruce L. Rollman, M.D., M.P.H., professor of medicine, psychiatry, biomedical informatics and clinical and translational science at the University of Pittsburgh School of Medicine. "Providing mental and physical health care together will allow us to determine whether this approach will not only improve quality of life, but also reduce rates of hospital readmissions, health care costs and mortality above and beyond traditional approaches to heart failure management - which typically neither screens for nor treats co-morbid depression."
Previous research by Dr. Rollman and his colleagues found that patients hospitalized for heart failure who screened positive with depressive symptoms experienced a 20 percent mortality rate at one year following discharge, compared to just 8 percent among similar heart failure patients who screened negative for depression. After they adjusted for age, gender and other health variables, depression was still associated with a three-fold increase in mortality.
The Hopeful Heart trial will include 750 participants recruited from several UPMC hospitals who meet severity criteria for heart failure and screen positive for depression both in the hospital and at two weeks after discharge over a three-year period. Eligible patients will be randomly assigned to receive either one year of a nurse-provided and telephone-delivered "blended" collaborative care intervention for treating both depression and heart failure, provided in coordination with patients' cardiologists and primary care physicians; a similar collaborative care intervention that addresses only their heart failure; or to their doctors' usual care for these conditions.
"If proven effective and cost-effective, the potentially more powerful and accessible blended care approach for treating heart failure and co-morbid depression could have profound implications for improving chronic illness care and stimulate development of similar interventions for integrating behavioral health into routine clinical care," Dr. Rollman said.
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