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Effects of structured heart failure disease management on mortality and morbidity depend on patients' mood: results from the Interdisciplinary Network for Heart Failure Study.
- Source :
-
European journal of heart failure [Eur J Heart Fail] 2014 Oct; Vol. 16 (10), pp. 1133-41. Date of Electronic Publication: 2014 Aug 20. - Publication Year :
- 2014
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Abstract
- Aims: Depression is common in heart failure (HF) and associated with adverse outcomes. Randomized comparisons of the effectiveness of HF care strategies by patients' mood are scarce. We therefore investigated in a randomized trial a structured collaborative disease management programme (HeartNetCare-HF™; HNC) recording mortality, morbidity, and symptoms in patients enrolled after hospitalization for decompensated systolic HF according to their responses to the 9-item Patient Health Questionnaire (PHQ-9) during an observation period of 180 days.<br />Methods and Results: Subjects scoring <12/≥12 were categorized as non-depressed/depressed, and those ignoring the questionnaire as PHQ-deniers. Amongst 715 participants (69 ± 12 years, 29% female), 141 (20%) were depressed, 466 (65%) non-depressed, and 108 (15%) PHQ-deniers. The composite endpoint of mortality and re-hospitalization was neutral overall and in all subgroups. However, HNC reduced mortality risk in both depressed and non-depressed patients [adjusted hazard ratios (HRs) 0.12, 95% confidence interval (CI) 0.03-0.56, P = 0.006, and 0.49, 95% CI 0.25-0.93, P = 0.03, respectively], but not in PHQ-deniers (HR 1.74, 95% CI 0.77-3.96, P = 0.19; P = 0.006 for homogeneity of HRs). Average frequencies of patient contacts in the HNC arm were 12.8 ± 7.9 in non-depressed patients, 12.4 ± 7.1 in depressed patients, and 5.5 ± 7.2 in PHQ-deniers (P < 0.001).<br />Conclusions: Early after decompensation, HNC reduced mortality risk in non-depressed and even more in depressed subjects, but not in PHQ-deniers. This suggests that differential acceptability and chance of success of care strategies such as HNC might be predicted by appropriate assessment of patients' baseline characteristics including psychological disposition. These post-hoc results should be reassessed by prospective evaluation of HNC in larger HF populations.<br /> (© 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.)
- Subjects :
- Aged
Comorbidity
Female
Hospitalization statistics & numerical data
Humans
Male
Middle Aged
Outcome Assessment, Health Care
Risk Assessment
Surveys and Questionnaires
Survival Analysis
Depression epidemiology
Depression physiopathology
Depression therapy
Disease Management
Heart Failure mortality
Heart Failure psychology
Heart Failure therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0844
- Volume :
- 16
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- European journal of heart failure
- Publication Type :
- Academic Journal
- Accession number :
- 25142121
- Full Text :
- https://doi.org/10.1002/ejhf.150