Clinicians at the University of Pittsburgh discovered that a telephone-delivered nursing care strategy that coupled heart failure care management with depression therapy improved patients’ clinical results. The results of the Hopeful Heart clinical study were published today in JAMA Internal Medicine.
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.Bruce Rollman
The Hopeful Heart Trial is the first to use a “blended” collaborative care method to treat heart failure and depression, in which researchers trained medical nurses to provide depression and heart failure treatment under the supervision 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.”
Despite the fact that depression affects up to half of all heart failure patients and has been linked to worse adherence to prescribed heart failure therapy, greater rates of hospital readmission, and increased mortality, cardiologists seldom test their patients for depression. One possible explanation is that little research has looked into the effects of depression therapy on the recovery of heart failure patients.
The researchers used a telephone-delivered ‘blended’ form of collaborative care to see if effective depression therapies might be offered as part of normal heart failure care. Medical nurses trained to provide depression care conducted weekly care-review conference calls with a study psychiatrist and cardiologist and then transmitted treatment recommendations to patients and their primary care physicians.
Following that, study nurses called patients on a frequent basis to assess their progress and provide recommendations for changes in care based on the patients’ responses to therapy.
“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 included 756 heart failure patients from eight Pittsburgh-area hospitals, with 629 of them testing positive for depression. Patients receiving ‘blended’ care 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 patients receiving collaborative care for heart failure alone, at a 12-month follow-up.
The researchers hope that this novel and practical method to patient care will be adopted more widely, especially since that patients and healthcare professionals are more familiar with 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).