Integrated treatment for depression and heart failure improves quality
of life and mood

Date:
August 30, 2021
Source:
University of Pittsburgh
Summary:
Results suggest that simple measures, such as depression care
administered by phone, can make a big difference for patients
recovering from heart failure.



FULL STORY ==========================================================================
A telephone-delivered nursing care strategy that combined heart failure
care management with depression treatment improved patients' clinical
outcomes, discovered clinicians from the University of Pittsburgh. The
findings of the clinical trial, called Hopeful Heart, were published
today in JAMA Internal Medicine.


==========================================================================
The Hopeful Heart Trial is the first study to apply a 'blended'
collaborative care approach to treating heart failure and depression,
whereby investigators trained medical nurses to deliver depression and
heart failure care under guidance of a study cardiologist, psychiatrist
and primary care physician.

"Heart failure is one of the most common cardiovascular diseases in the
United States, and it's growing even more prevalent as the population
ages," said lead author Bruce Rollman, M.D., M.P.H., UPMC endowed
chair and professor of medicine at Pitt. "I'm very excited about
our results because they show that we can successfully train medical
nurses to deliver effective depression care as part of heart failure
care management they may already be delivering, and that this pragmatic approach can significantly improve patients' mood and help them regain
a better quality of life." Cardiologists rarely screen their patients
for depression, even though it occurs in up to half of all heart failure patients and has been associated with reduced adherence to recommended
heart failure care, higher rates of hospital readmission and increased mortality. One potential explanation is that few studies have examined
the benefits of depression treatment on heart failure patients' recovery.

To find out if effective depression treatments can be delivered as part of routine heart failure care, the researchers tested a telephone-delivered 'blended' model of collaborative care. Medical nurses who were trained to administer depression care had weekly care-review conference calls with
a study psychiatrist and a study cardiologist, and then relayed treatment recommendations to patients and their primary care physicians. Afterward,
study nurses monitored patients via regular telephone calls and made recommendations for adjustments in care depending on patients' responses
to treatment.

"Collaborative 'blended' care model provides extra layers of emotional
and educational support for patients and their families," said co-author
Amy Anderson, M.S., clinical coordinator for the Hopeful Heart Trial at
Pitt. "When we sit in on case review sessions with doctors and nurses,
we end up learning a great deal about these patients' lives; it becomes personal. So, it is always very rewarding to see these patients overcome hurdles and improve over time." Hopeful Heart recruited 756 participants
with heart failure from eight Pittsburgh-area hospitals, including 629
patients who screened positive for depression. At 12-months follow-up, 'blended' care patients reported better mental health-related quality
of life -- including fewer limitations in social activities, improved
general well-being, higher energy and less fatigue, and improved mood -- compared to patients receiving usual care, and improved mood compared
to those who received collaborative care for heart failure alone.

The researchers hope that this innovative and practical approach to
patient care could be implemented more broadly, especially as both
patients and health care workers have become more accustomed to
telemedicine than ever before.

"Depression often goes unrecognized and untreated in heart failure
patients, and we are encouraged that our integrated approach to addressing depression was not only effective, but that it can be easily scaled up and expanded nationally," Rollman said. "A 'blended' collaborative care that
is built on existing systems of care also may enable organized health care systems such as UPMC to deliver effective first-line care for depression
and other mental health conditions to patients with complex medical conditions." Other authors of the study include Scott Rothenberger,
Ph.D., Kaleab Abebe, Ph.D., Ravi Ramani, M.D., Matthew Muldoon, M.D.,
M.P.H., John Jakicic, Ph.D., Bea Herbeck Belnap, Dr.Bio.Hum., and Jordan
Karp, M.D., all of Pitt.

This research was supported by the National Heart, Lung, and Blood
Institute (grant # R01 HL114016).

========================================================================== Story Source: Materials provided by University_of_Pittsburgh. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Bruce L. Rollman et al. Efficacy of Blended Collaborative Care for
Patients With Heart Failure and Comorbid DepressionA
Randomized Clinical Trial. JAMA Internal Medicine, 2021 DOI:
10.1001/jamainternmed.2021.4978 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/08/210830113314.htm

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