In:
European Journal of Heart Failure, Wiley, Vol. 16, No. 10 ( 2014-10), p. 1133-1141
Abstract:
Depression is common in heart failure ( HF ) and associated with adverse outcomes. Randomized comparisons of the effectiveness of HF care strategies by patients' mood are scarce. We therefore investigated in a randomized trial a structured collaborative disease management programme ( HeartNetCare‐HF ™; HNC ) recording mortality, morbidity, and symptoms in patients enrolled after hospitalization for decompensated systolic HF according to their responses to the 9‐item Patient Health Questionnaire ( PHQ ‐9) during an observation period of 180 days. Methods and results Subjects scoring 〈 12/≥12 were categorized as non‐depressed/depressed, and those ignoring the questionnaire as PHQ ‐deniers. Amongst 715 participants (69 ± 12 years, 29% female), 141 (20%) were depressed, 466 (65%) non‐depressed, and 108 (15%) PHQ ‐deniers. The composite endpoint of mortality and re‐hospitalization was neutral overall and in all subgroups. However, HNC reduced mortality risk in both depressed and non‐depressed patients [adjusted hazard ratios ( HRs ) 0.12, 95% confidence interval ( CI ) 0.03–0.56, P = 0.006, and 0.49, 95% CI 0.25–0.93, P = 0.03, respectively], but not in PHQ ‐deniers ( HR 1.74, 95% CI 0.77–3.96, P = 0.19; P = 0.006 for homogeneity of HRs ). Average frequencies of patient contacts in the HNC arm were 12.8 ± 7.9 in non‐depressed patients, 12.4 ± 7.1 in depressed patients, and 5.5 ± 7.2 in PHQ ‐deniers ( P 〈 0.001). Conclusions Early after decompensation, HNC reduced mortality risk in non‐depressed and even more in depressed subjects, but not in PHQ ‐deniers. This suggests that differential acceptability and chance of success of care strategies such as HNC might be predicted by appropriate assessment of patients' baseline characteristics including psychological disposition. These post‐hoc results should be reassessed by prospective evaluation of HNC in larger HF populations.
Type of Medium:
Online Resource
ISSN:
1388-9842
,
1879-0844
DOI:
10.1002/ejhf.2014.16.issue-10
Language:
English
Publisher:
Wiley
Publication Date:
2014
detail.hit.zdb_id:
1500332-2
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