2012


To access this material please log in or register

Register Authorize
2012/№6

Depression in patients with severe heart failure: role of hospital training and ambulatory self-testing

Berdnikov S. V., Vishnevskiy V. I., Berdnikova O. A.

Keywords: depression, training of patients, CHF

DOI: 10.18087/rhfj.2012.6.1756

Relevance. Nowadays strategy of ambulatory self-testing is considered an integral part of «disease management programs». Objective. Influence of various strategies of ambulatory conduct of patients with severe CHF on functional status of patients, treatment compliance and severity of depression was studied. Materials and methods. 122 patients with CHF FC III–IV (NYHA) were randomized to 3 groups: group 1 – ambulatory self-testing after hospital training in «School for CHF patients», group 2 – hospital training in «School for CHF patients», group III – control. Patients from group 1, in case of occurrence of edemas / dyspnea could independently administer torasemide (according to the schedule) under strict control of blood electrolytes and creatinine. If treatment is ineffective, patients of group 1 consulted a doctor by phone. During hospitalization and in 3, 6 and 9 month out-patient follow-up periods, functional condition of patients, severity of depression, treatment compliance, level of knowledge about CHF were estimated. Results. Rates of depressive disorders at enrollment to the study were 87.8, 90.2 and 85 % in groups 1, 2 and 3, respectively. Severity of depression by the end of the study in group 1 was significantly less in comparison with the control group and averaged 17 (12–21) vs. 20.5 (15.5–24) points. The distance in the 6‑minute walk test in group 1 by the 9th month of the study increased, on the average, from 174.5 (108–231.5) m to 248.5 (142–324) m; in groups 2 and 3 – significantly did not changed. Level of knowledge about CHF by the end of the study in group 1 was significantly greater in comparison with groups 2 and 3. By the end of the study, high treatment compliance in group 1 was revealed in 76.9 %, in group 2–17.9 %, in group 3–8.3 % cases. Feedback interrelations between level of depression, on the one hand, and distance in the 6‑minute walk test, patient’s level of knowledge about CHF and their compliance with treatment, on the other hand, were revealed. Patient’s level of knowledge about CHF is directly correlated with their compliance with treatment. Conclusion. Use of ambulatory self-testing strategy in patients with severe HF in comparison with standard model of care (including those who had been hospitalized) produce significant improvement of patients’ condition, decrease prevalence of severe depression, improve compliance with treatment.
  1. Guck TP, Elsasser GN, Barone EJ. Depression and congestive heart failure.Congest Heart Fail. 2003;9 (3):163–169.
  2. Koenig HG. Depression in hospitalized older patients with congestive heart failure. Gen Hosp Psychiatry. 1998;20 (1):29–43.
  3. Rutledge T, Reis VA, Linke SE et al. Depression in heart failure: a meta-analytic review of prevalence, intervention effects, and associations with clinical Outcomes. J Am Coll Cardiol. 2006;48 (8):1527–1537.
  4. Oganov RG. In.: Proceedings of the Symposium on «Depression in cardiology: more than a risk factor,» Russian National Congress of Cardiology. M.2003:1–4.
  5. Kutuzova AE, Alekseeva NP, Petrova NN et al. Mental status and quality of life of patients with chronic heart failure. Heart failure. 2007;8 (5):222–224.
  6. Carels RA. The association between disease severity, functional status, depression and daily quality of life in congestive heart failure patients. Qual Life Res. 2004;13 (1):63–72.
  7. Murberg TA, Bru E, Aarsland T, Svebak S. Functional status and depression among men and women with congestive heart failure. Int J Psychiatry Med. 1998;28 (3):273–291.
  8. Plotsky PM, Owens MJ, Nemeroff CB. Psychoneuroendocrinology of depression. Hypothalamic-pituitary-adrenal axis. Psychiatr Clin North Am. 1998;21 (2):293–307.
  9. MERIT-HF study group. Effect of metoprolol CR / XL in chronic heart failure: Metoprolol CR / XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999;353 (9169):2001–2007.
  10. Khand A, Gemmel I, Clark AL, Cleland JG. Is the prognosis of heart failure improving? J Am Coll Cardiol. 2000;36 (7):2284–2286.
  11. Ghali JK, Kadakia S, Cooper R et al. Precipitating factors leading to decompensation of heart failure. Traits among urban blacks. Arch Intern Med. 1988;148 (9):2013–2016.
  12. Chan D, Heidenreich P, Weinstein M. Heart failure disease management programs: A cost-effectiveness analysis. Am Heart J. 2008;155 (2):332–338.
  13. First open study syndrome of acute decompensated heart failure and related diseases in the Russian Federation – an epidemiological study ORACLE – RF. Доступно на: http://www.ingorts.ru / index.php / en / m-research / m-oracul
  14. Boratav C. The Boratav Depression Screening Scale (Bordepta): a sensitive scale for recognizing depression in epidemiologic stu­dies and primary health care. Turk Psikiyatri Derg. 2003;14 (3):172–183.
  15. Giliarevskiĭ SR, Orlov VA, Khamaganova LK et al. Effect of therapeutic education of patients with chronic heart failure on quality of life and requirement of rehospitalizations. Results of 12‑months randomized study. Kardiologiia. 2002;42 (5):56–61.
  16. Boyde M, Tuckett A, Peters R et al. Learning style and learning needs of heart failure patients (The Need2Know-HF patient study). Eur J Cardiovasc Nurs. 2009;8 (5):316–322.
  17. Jaarsma T, Lesman-Leegte I, Hillege HL et al. Depression and the usefulness of a disease management program in heart failure: insights from the COACH (Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure) study. J Am Coll Cardiol. 2010;55 (17):1837–1843.
  18. Krumholz HM, Amatruda J, Smith GL et al. Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. J Am Coll Cardiol. 2002;39 (1):83–89.
  19. Gonseth J, Guallar-Castillon P, Banegas JR, Rodriguez-Artalejo F. The effectiveness of disease management programmes in reducing hospital re-admission in older patient with heart failure: a systematic review and meta-analysis of published reports. Eur Heart J. 2004;25 (18):1570–1595.
Berdnikov S. V., Vishnevskiy V. I., Berdnikova O. A. Depression in patients with severe heart failure: role of hospital training and ambulatory self-testing. Russian Heart Failure Journal. 2012;13(6):347-354

To access this material please log in or register

Register Authorize
Ru En