Blended Collaborative Care for Treating Heart Failure and Co-Morbid Depression - Hopeful Heart

Mar 16, 2019
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Presenter/Author:
Bruce L. Rollman, MD,MPH
Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
National Heart, Lung, and Blood Institute
Date Presented:
03/16/2019
Date Updated:
03/16/2019
Original Posted Date:
03/16/2019
References

Contribution To Literature:

The Hopeful Heart trial showed that collaborative care for heart failure and depression was superior at improving quality of life.

Description:

The goal of the trial was to evaluate collaborative care for co-morbid heart failure and depression compared with usual care among patients recently hospitalized for heart failure.


Study Design

  • Randomized
  • Parallel

Patients with recent hospitalization for heart failure who screened positive for depression were randomized to the ‘blended’ group (collaborative care for heart failure and depression; n = 250) versus ‘enhanced usual care’ group (collaborative care for heart failure alone; n = 250) versus ‘usual care’ group (usual care for heart failure and depression; n = 125). There was also a control group that screened negative for depression (n = 125).

The blended care group consisted of a psychiatrist, cardiologist, internist, and nurse, while the enhanced care group consisted of a cardiologist, internist, and nurse.

Inclusion criteria:

  • Left ventricular ejection fraction ≤45%
  • Medically stable
  • Consent for depression screening
  • No substance abuse or dementia
  • Discharged home
  • Total number of enrollees: 750
  • Duration of follow-up: 12 months
  • Mean patient age: 64 years
  • Percentage female: 33%
  • Percentage with diabetes: 52%

Other salient features/characteristics:

  • Positive screen for depression = 46%

Principal Findings:

There was an improvement in health-related quality of life at 12 months for blended care versus usual care (odds ratio [OR] 0.34, p = 0.002).

Secondary outcomes:

  • Improvement in mood symptoms at 12 months for blended care versus usual care (OR 0.47, p < 0.0001)
  • No difference in readmission between the groups (p = 0.49)
  • No difference in mortality between the groups (p = 0.79)

Interpretation:

Among patients with recent hospitalization for heart failure who screened positive for depression, a blended collaborative care approach was beneficial at improving health-related quality of life compared with usual care. The blended collaborative care consisted of a psychiatrist, cardiologist, internist, and nurse. Depression is common among patients recently hospitalized for heart failure. The blended collaborative care approach was also associated with an improvement in mood symptoms. There was no difference in readmissions and mortality within 12 months between the groups. 

References:

Presented by Dr. Bruce Rollman at the American College of Cardiology Annual Scientific Session (ACC 2019), New Orleans, LA, March 16, 2019.

Keywords: ACC19, ACC Annual Scientific Session, Comorbidity, Depression, Heart Failure, Quality of Life, Secondary Prevention, Stroke Volume


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