Researchers discovered CBT was effective for depression but not for heart failure self-care or physical functioning, as compared to enhanced usual care.
Heart failure occurs when the heart does not pump as well as it should. The condition requires aggressive self-care in the form of medication management, diet, and appropriate levels of activity.
Heart failure is one of the most common reasons for hospitalization, and care for the condition is very expensive. Depression and inadequate self-care heighten the risk of hospitalization and death in patients with the illness.
Self-care includes behaviors that maintain physical functioning and prevent acute exacerbations, such as following a low-sodium diet, exercising, and taking prescribed medications, according to background information in the article.
In the study, published online by JAMA Internal Medicine, Kenneth E. Freedland, Ph.D., of the Washington University School of Medicine, St. Louis, and colleagues randomly assigned 158 outpatients with heart failure and major depression to cognitive-behavioral therapy (CBT) delivered by experienced therapists plus usual care (UC; n = 79) or UC alone (n = 79).
Usual care was enhanced in both groups with a structured heart failure education program delivered by a cardiac nurse. The intervention treatment followed standard CBT manuals and a supplemental manual on CBT for cardiac patients.
The intensive phase of the intervention consisted of up to six months of weekly one hour sessions. Sessions tapered to biweekly and then monthly between the end of intensive (weekly) treatment and six months post-randomization.
One hundred thirty-two (84 percent) of the participants completed the six month posttreatment assessments; 60 (76 percent) of the UC and 58 (73 percent) of the CBT participants completed every follow-up assessment.
Six-month depression scores were lower in the CBT than the UC group. CBT did not improve heart failure self-care or physical functioning, but it did improve anxiety, fatigue, social functioning and quality of life, and additional analysis suggested that the intervention might help to decrease the hospitalization rate in clinically depressed patients.
The finding that CBT was successful for depression is important; CBT could possibly be used to manage depression even if antidepressant therapy is unsuccessful. Alternatively, CBT may be used alone for depression care rather than pharmaceutical management.
“The results suggest that CBT is superior to usual care for depression in patients with HF,” the researchers write.
“Further research is needed on interventions to improve depression, self-care, physical functioning, and quality of life in patients with HF and comorbid major depression.”