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
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.
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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