Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure
-
Published:2024-01-17
Issue:1
Volume:7
Page:e2352094
-
ISSN:2574-3805
-
Container-title:JAMA Network Open
-
language:en
-
Short-container-title:JAMA Netw Open
Author:
IsHak Waguih William12, Hamilton Michele A.3, Korouri Samuel1, Diniz Marcio A.4, Mirocha James4, Hedrick Rebecca1, Chernoff Robert1, Black Jeanne T.5, Aronow Harriet6, Vanle Brigitte1, Dang Jonathan1, Edwards Gabriel1, Darwish Tarneem1, Messineo Gabrielle1, Collier Stacy1, Pasini Mia1, Tessema Kaleab K.2, Harold John G.3, Ong Michael K.2, Spiegel Brennan7, Wells Kenneth2, Danovitch Itai1
Affiliation:
1. Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California 2. David Geffen School of Medicine at UCLA, Los Angeles, California 3. Smidt Heart Institute, Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 4. Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, California 5. Cedars-Sinai Health System, Los Angeles, California 6. Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California 7. Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, California
Abstract
ImportanceHeart failure (HF) affects more than 6 million adults in the US and more than 64 million adults worldwide, with 50% prevalence of depression. Patients and clinicians lack information on which interventions are more effective for depression in HF.ObjectiveTo compare the effectiveness of behavioral activation psychotherapy (BA) vs antidepressant medication management (MEDS) on patient-centered outcomes inpatients with HF and depression.Design, Setting, and ParticipantsThis pragmatic randomized comparative effectiveness trial was conducted from 2018 to 2022, including 1-year follow-up, at a not-for-profit academic health system serving more than 2 million people from diverse demographic, socioeconomic, cultural, and geographic backgrounds. Participant included inpatients and outpatients diagnosed with HF and depression, and data were analyzed as intention-to-treat. Data were analyzed from 2022 to 2023.InterventionsBA is an evidence-based manualized treatment for depression, promoting engagement in personalized pleasurable activities selected by patients. MEDS involves the use of an evidence-based collaborative care model with care managers providing coordination with patients, psychiatrists, and primary care physicians to only administer medications.Main Outcomes and MeasuresThe primary outcome was depressive symptom severity at 6 months, measured using the Patient Health Questionnaire 9-Item (PHQ-9). Secondary outcomes included physical and mental health-related quality of life (HRQOL), measured using the Short-Form 12-Item version 2 (SF-12); heart failure-specific HRQOL, measured using the Kansas City Cardiomyopathy Questionnaire; caregiver burden, measured with the Caregiver Burden Questionnaire for Heart Failure; emergency department visits; readmissions; days hospitalized; and mortality at 3, 6, and 12 months.ResultsA total of 416 patients (mean [SD] age, 60.71 [15.61] years; 243 [58.41%] male) were enrolled, with 208 patients randomized to BA and 208 patients randomized to MEDS. At baseline, mean (SD) PHQ-9 scores were 14.54 (3.45) in the BA group and 14.31 (3.60) in the MEDS group; both BA and MEDS recipients experienced nearly 50% reduction in depressive symptoms at 3, 6, and 12 months (eg, mean [SD] score at 12 months: BA, 7.62 (5.73); P < .001; MEDS, 7.98 (6.06); P < .001; between-group P = .55). There was no statistically significant difference between BA and MEDS in the primary outcome of PHQ-9 at 6 months (mean [SD] score, 7.53 [5.74] vs 8.09 [6.06]; P = .88). BA recipients, compared with MEDS recipients, experienced small improvement in physical HRQOL at 6 months (mean [SD] SF-12 physical score: 38.82 [11.09] vs 37.12 [10.99]; P = .04), had fewer ED visits (3 months: 38% [95% CI, 14%-55%] reduction; P = .005; 6 months: 30% [95% CI, 14%-40%] reduction; P = .008; 12 months: 27% [95% CI, 15%-38%] reduction; P = .001), and spent fewer days hospitalized (3 months: 17% [95% CI, 8%-25%] reduction; P = .002; 6 months: 19% [95% CI, 13%-25%] reduction; P = .005; 12 months: 36% [95% CI, 32%-40%] reduction; P = .001).Conclusions and RelevanceIn this comparative effectiveness trial of BA and MEDS in patients with HF experiencing depression, both treatments significantly reduced depressive symptoms by nearly 50% with no statistically significant differences between treatments. BA recipients experienced better physical HRQOL, fewer ED visits, and fewer days hospitalized. The study findings suggested that patients with HF could be given the choice between BA or MEDS to ameliorate depression.Trial RegistrationClinicalTrials.gov Identifier: NCT03688100.
Publisher
American Medical Association (AMA)
|
|