SAN DIEGO – Patients with heart failure on optimal medical therapy who received a multidisciplinary, nonpharmacologic intervention for follow-up care and observation had a 38% reduction in death and rehospitalization for heart failure at 1 year, compared with patients who received usual care.
They also experienced significant improvements in depression scores from baseline, compared with their counterparts, Dr. Viacheslav Mareev reported at the annual meeting of the Heart Failure Society of America.
Dr. Viacheslay Mareey
“It’s well known that many patients with congestive heart failure have depression,” said Dr. Mareev of the Russian Society of Heart Failure Specialists, Moscow. A recent meta-analysis of trials studying the association found that the prevalence ranges from 19% to 34%, and that the prevalence of depression worsens as heart failure worsens (J. Am. Coll. Cardiol. 2006;48:1527-37).
For the current trial, known as CHANCE (Congestive Heart Failure: A Multidisciplinary Nonpharmacological Approach for Changing in Rehospitalization and Prognosis), Dr. Mareev and his associates at 38 sites in 24 cities in Russia randomized 385 patients with New York Heart Association class III or IV heart failure to receive optimal medical treatment plus usual care, and 360 patients to receive optimal medical treatment plus education and observation by a multidisciplinary team of clinicians.
Patients in the intervention group attended four 30-minute, in-hospital educational sessions about how to live optimally with heart failure. After discharge, bilateral phone contact was made once weekly during the first month, twice a month until month 6, and then monthly until month 12. To date, none of the patients has been lost to follow-up, Dr. Mareev said.
Both groups of patients completed the HADS (Hospital Anxiety and Depression Scale) at baseline and at 12 months. In this scale, a score of less than 7 suggests the absence of anxiety and/or depression, a score of 7-10 suggests subclinical or minor anxiety and/or depression, and a score greater than 10 suggests clinically relevant, severe anxiety and/or depression.
The mean age of the study participants was 63 years, 60% were male, and 72% had NYHA class III heart failure.
Dr. Mareev reported that patients in the intervention group had a 38% reduction in death and rehospitalization for heart failure, compared with patients in the usual-care group.
Baseline HADS scores in the intervention group fell significantly (from 9.7 at baseline to 7.1 at 1 year), whereas scores in the usual-care group dropped slightly but not significantly (from 9.3 to 8.7). Dr. Mareev said that the number of patients who scored greater than 10 on the HADS dropped slightly between baseline and 1 year for patients in the usual-care group (from 31% to 30%), but dropped markedly for patients in the intervention group (from 37% to 18%).
The relative risk of death among all patients who scored greater than 10 on the HADS was 50% higher, compared with patients who scored 7-10 or less than 7.
Patients in the intervention group who scored less than 10 on the HADS had a 25% relative risk reduction of death, compared with their counterparts in the usual-care group, whereas patients in the intervention group who scored greater than 10 on the HADS had a 17% relative risk reduction of death, compared with their counterparts in the usual-care group.
The multidisciplinary intervention improved the prognosis of heart failure, “even in the group of patients with clinically relevant depression,” Dr. Mareev concluded.
The results support the recent findings of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial, which found that a nonmedical intervention by a specially trained nurse improved prognosis and matched the efficacy of sertraline (J. Am. Coll. Cardiol. 2010;56:692-9). At the meeting, the one of the investigators of that trial, Dr. Christopher M. O’Connor of Duke University in Durham, N.C., said that the CHANCE study “confirms that depression is an important risk factor and confers an increased risk in morbidity and mortality” in heart failure. “This is an important advance in the field. We need more long-term studies like this.”
Dr. Mareev said that he had no relevant financial conflicts to disclose.