Both psychotherapy and antidepressants feasible options for managing depression in HF patients: JAMA

The comparative effectiveness randomized clinical trial (RCT) including 416 adults showed that BA and MEDS recipients experienced nearly 50% reduction of depressive symptoms at 3, 6, and 12 months, with no statistically significant differences between treatments.

"BA recipients experienced an improvement in physical health-related quality of life, fewer days hospitalized, and fewer emergency department (ED) visits compared with MEDS recipients," the researchers reported in their study published in JAMA Network Open. 

BA is an evidence-based annualized treatment for depression that promotes engagement in personalized pleasurable activities selected by patients. MEDS involves using an evidence-based collaborative care model with care managers providing coordination with psychiatrists, patients, and primary care physicians to only administer medications.

More than 6 million adults in the US and more than 64 million adults worldwide are affected by heart failure (HF), with a 50% prevalence of depression. Clinicians and patients lack information on the effective interventions for depression in HF. Waguih William IsHak, Cedars-Sinai Medical Center, Los Angeles, California, and colleagues compared the effectiveness of behavioural activation psychotherapy versus antidepressant medication management (MEDS) on patient-centred outcomes in patients with heart failure and depression.

For this purpose, the research team conducted a pragmatic randomized comparative effectiveness trial from 2018 to 2022, including 1-year follow-up. Participants included inpatients and outpatients diagnosed with HF and depression, and data were analyzed as intention-to-treat.

The primary outcome was the severity of depressive symptoms at six months, measured using the Patient Health Questionnaire 9-Item (PHQ-9). Secondary outcomes were heart failure-specific health-related quality of life (HRQOL), measured using the Kansas City Cardiomyopathy Questionnaire; mental and physical HRQOL, measured using the Short-Form 12-Item version 2 (SF-12); emergency department visits; caregiver burden, measured with the Caregiver Burden Questionnaire for Heart Failure; mortality at 3, 6, and 12 months; and days hospitalized.

Four hundred and sixteen patients (mean age, 60.71 years; 58.41% males) were enrolled, 208 patients randomized to BA and 208 patients to MEDS.

The study led to the following findings:

• At baseline, mean PHQ-9 scores were 14.54 in the BA group and 14.31 in the MEDS group; both BA and MEDS recipients experienced nearly 50% reduction in depressive symptoms at 3, 6, and 12 months.
• There was no statistically significant difference between BA and MEDS in the primary outcome of PHQ-9 at six months (mean score, 7.53 vs 8.09).
• BA recipients, compared with MEDS recipients, experienced a small improvement in physical HRQOL at 6 months (mean SF-12 physical score: 38.82 vs 37.12), had fewer ED visits (3 months: 38% reduction; 6 months: 30% reduction; 12 months: 27% reduction), and spent fewer days hospitalized (3 months: 17% reduction; 6 months: 19% reduction; 12 months: 36% reduction).

The comparative effectiveness trial of BA and MEDS in heart failure patients experiencing depression showed that both treatments significantly reduced depressive symptoms by 50% with no statistically significant differences between treatments.

BA recipients experienced fewer ED visits, better physical HRQoL, and fewer days hospitalized.

"The study findings indicate that patients with HF could be given the choice between BA or MEDS to ameliorate depression," the researchers concluded.

Reference:

IsHak WW, Hamilton MA, Korouri S, et al. Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(1):e2352094. doi:10.1001/jamanetworkopen.2023.52094