Heart failure leads to depression. Or is it the other way around?
Doctors working on that medical chicken-or-egg issue long have realized an association between heart failure and depression. But questions still remain whether successful treatment of depression for those with heart failure can extend their lives.
The University of Pittsburgh has landed a $7.3 million grant through the National Institutes of Health to try answering this question -- and more.
The five-year Hopeful Heart clinical trial will use a "collaborative-care model" to train care managers for patients with heart failure to recognize depressive symptoms and alert team cardiologists and psychiatrists to initiate treatment. For now, managers focus on the medical not mental issues affecting those with heart failure.
"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 Hope Heart trial will help us find out," said Bruce L. Rollman, a professor at the Pitt School of Medicine who will lead the study.
The team will recruit 750 participants from UPMC hospitals who meet severity criteria for heart failure and also screen positive for depression. Randomly the eligible patients will receive either one year of nurse-provided, telephone-delivered care including treatments for heart failure and depression. Another group will receive only cardiology care for heart failure.
The trial will determine whether combined mental and physical health care will improve patients' quality of life and reduce hospital readmissions, health care costs and mortality as compared with the current approach that precludes screening for depression in heart-failure patients.
Dr. Rollman said overlapping symptoms for heart failure and depression include lack of energy and trouble sleeping. "But a person with depression also has a loss of interest."
About 5.1 million Americans have heart failure, with approximately one quarter of them also experiencing depression. Heart failure represents the No. 1 cause of hospitalizations for Medicare, Dr. Rollman said.
Heart failure doesn't mean the heart has stopped working or is about to. But it does indicate the heart no longer can pump enough blood to meet the body's needs. "In some cases, the heart can't fill with enough blood," the institute's website says. In other cases, the heart can't pump blood to the rest of the body with enough force. Some people have both problems," states the website of NIH's National Heart, Lung, and Blood Institute, which is funding the Pitt study.
Susan Czajkowski, the institute's project manager, said she hopes the study will answer important questions about the biological mechanism between depression and heart disease and whether the collaborative model will work to improve patients' quality and length of life while reducing hospital readmissions and health care costs.
"This is a high priority for us," she said. "It is a different model for caring for these patients with these conditions. Ordinarily we treat a patient in the doctor's office then send the patient to others to treat depression and they can get lost in the mix."
In a 2009 study published in the Journal of the American Medical Association, Dr. Rollman and his team showed that patients screened and treated for depression after bypass surgery recovered faster than those not treated for depression. Then in a 2012 study of 471 UPMC patients, in support of the Hopeful Heart trial, Dr. Rollman and his team showed that people hospitalized for heart failure who also tested positive for depressive symptoms experienced a 20-percent mortality rate one year after discharge, compared with just 8 percent of similar heart-failure patients who screened negative for depression.
After the researchers adjusted for age, gender and other health variables, depression still was associated with a three-fold increase in mortality.
David Templeton: email@example.com or 412-263-1578.