A Hopeful Heart: Pitt Examines Benefits of Depression Treatment for Heart Failure Patients

Can treating depression in patients with heart failure help them live longer? That’s one of the questions that University of Pittsburgh researchers expect to answer with a new five-year, $7.3 million grant from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

Nearly six million Americans live with heart failure, according to government estimates. Studies confirm that about a quarter of them suffer from depression.

“Evidence-based depression treatments clearly improve health-related quality of life, yet it is presently unknown whether they also reduce morbidity and mortality, particularly in patients with cardiovascular disease. The Hopeful Heart trial will help us find out,” said principal investigator Bruce L. Rollman, a Pitt professor of medicine. “Providing mental and physical health care together will allow us to determine whether this approach will not only improve quality of life, but also reduce rates of hospital readmissions, health care costs, and mortality above and beyond traditional approaches to heart failure management—which typically neither screens for nor treats co-morbid depression.”

Previous research by Rollman and his colleagues found that patients hospitalized for heart failure who screened positive with depressive symptoms experienced a 20 percent mortality rate at one year following discharge. That compared to just eight percent among similar heart failure patients who screened negative for depression. After they adjusted for age, gender, and other health variables, depression was still associated with a three-fold increase in mortality. 

The Hopeful Heart trial will include 750 participants recruited from several UPMC hospitals who meet severity criteria for heart failure and who screen positive for depression. Eligible patients will be randomly assigned to one of three regimens: one year of a nurse-provided and telephone-delivered “blended” care intervention for treating both depression and heart failure, coordinated with patients’ cardiologists and primary care doctors; a similar collaborative-care intervention that addresses only heart failure; or doctors’ usual care for these conditions.

Rollman—who also is a professor of psychiatry, biomedical informatics, and clinical and translational science in Pitt’s School of Medicine—said that should the blended-care approach prove medically sound and cost effective, it could have “profound implications for improving chronic illness care and stimulate development of similar interventions for integrating behavioral health into routine clinical care.”

The study’s coinvestigators include Bea Herbeck Belnap, Kaleab Abebe, Indrani Halder, John M. Jakicic, Jordan F. Karp, Zachary A. Marcum, Matthew F. Muldoon, Ravi Ramani, Charles F. Reynolds III, and Kenneth J. Smith, all of the University of Pittsburgh.