To access this material please log in or register

Register Authorize

Disease management programs for the heart failure patients. Is there any CHANCE to defeat depression and anxiety Post-hoc analysis of CHANCE trial (Congestive Heart Failure: A multidisciplinary Non-pharmacological approach for Changing in rE-hospitalizat

Begrambekova Yu. L.1, Mareev V. Yu.1, Drobizhev M. Yu.2
1 – Federal State Budgetary Educational Institution of Higher Education, "M.V.Lomonosov Moscow State University", Leninskie Gory 1, GSP-1, Moscow 119991
2 – Federal State Budgetary Educational Institution of Higher Education, "I. M. Sechenov First Moscow State Medical University" of the Ministry of Health of the Russian Federation, Trubetskaya 8, Bldg. 2, Moscow 119991

Keywords: heart failure, training of patients, depression, 6-min walk test, clinical condition scale (CCS), anxiety, outpatient control

DOI: 10.18087/rhfj.2016.6.2281

Background. Patients with CHF suffer considerable impairment of all life quality aspects related with both symptoms of disease and progressive difficulties in social functioning. Aim. To study the effect of Program for education and active outpatient control on the course of depressive and anxiety disorders in patients with HF and to study mechanisms which provide the effect of the Program. Materials and methods. The study included patients hospitalized for diagnosed FC III–IV CHF. The patients were randomized to treatment and control groups. The groups did not differ in severity of CH and pronouncement of depressive and anxiety symptoms. During the stay in the hospital and after stabilization of the condition, patients of the treatment group underwent a structured training. The active outpatient control was performed by telephone contacts. Patients of the control group were managed according to the routine health care practice. At study weeks 0, 24, and 52, patients took a test using the Hospital Anxiety and Depression Scale (HADS). Clinical condition of patients was evaluated using the CCS scale modified by V. Yu. Mareev and 6‑min walk test. Results. At week 0, the HADS test was performed for 737 patients. Pronounced depressive symptoms (HADS(d) score ≥11) was observed in 272 (37 %) patients; 465 (63 %) patients had no depression. The mean depression and anxiety scale score decreased after the end of observation in both groups. The decrease in symptom intensity was greater in patients of the treatment group compared to the control group (p<0.001). In addition, the odds for development of superthreshold-level depression and anxiety were significantly lower for patients of the treatment group. The odds for improving the condition by the anxiety scale were 2.26 times higher for female patients of the treatment group than for patients of the control group. Both in the treatment group and the control group, time-related changes in clinical symptoms were moderately correlated with changes in the psycho-emotional condition by HADS(a) and HADS(d) subscale scores. Conclusion. The Program for training and active outpatient control of patients with pronounced HF (FC III–IV) and depression and/or anxiety positively influenced their psycho-emotional condition. This effect was related with both their cardio-psychic (normalization of psycho-emotional condition due to reduced HF severity) and in a part of patients, a direct psychotherapeutic effect. Special programs focusing on training of patients with HF and active outpatient control of their condition can be considered an alternative to existing recommendations on management of such patients involving consulting specialists in the field of mental health and antidepressant therapy. Further studies are needed to specify algorithms for selection of a training program or a more traditional approach to treatment of depressive and anxiety symptoms in patients with HF.
  1. Pihl E, Jacobsson A, Fridlund B, Stromberg A, Martensson J. Depression and health-related quality of life in elderly patients suffering from heart failure and their spouses: a comparative study. Eur J Heart Fail. 2005 Jun;7 (4):583–9.
  2. Egede LE. Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. Gen Hosp Psychiatry. 2007 Sep-Oct;29 (5):409–16.
  3. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure: a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006 Oct 17;48 (8):1527–37.
  4. Thomas SA, Friedmann E, Khatta M, Cook LK, Lann AL. Depression in patients with heart failure: physiologic effects, incidence, and relation to mortality. AACN Clin Issues. 2003 Feb;14 (1):3–12.
  5. Sullivan M, Simon G, Spertus J, Russo J. Depression-related costs in heart failure care. Arch Intern Med. 2002 Sep 9;162 (16):1860–6.
  6. Thomas SA, Chapa DW, Friedmann E, Durden C, Ross A, Lee MC, Lee HJ. Depression in patients with heart failure: prevalence, pathophysiological mechanisms, and treatment. Crit Care Nurse. 2008 Apr;28 (2):40–55.
  7. Беленков Ю. Н. Влияние специализированных форм активного амбулаторного ведения на функциональный статус, качество жизни и показатели гемодинамики больных с выраженной сердечной недостаточностью. Результаты Российской программы ШАНС. Журнал Сердечная Недостаточность. 2008;8 (3):112–6 [Belenkov Yu. N. Vliyanie speczializirovanny`x form aktivnogo ambulatornogo vedeniya na funkczional`ny`j status, kachestvo zhizni i pokazateli gemodinamiki bol`ny`x s vy`razhennoj serdechnoj nedostatochnost`yu. Rezul`taty` Rossijskoj programmy` ShANS. Zhurnal Serdechnaya Nedostatochnost`. 2008;8 (3):112–6].
  8. Dekker RL. Cognitive therapy for depression in patients with heart failure: a critical review. Heart Fail Clin. 2011 Jan;7 (1):127–41.
  9. Мареев В. Ю., Беграмбекова Ю. Л., Даниелян М. О., Агеев Ф. Т., Гиляревский С. Р., Беленков Ю. Н., Середенина Е. М. Какие вопросы задаются и на какие вопросы способны ответить исследования по немедикаментозному лечению пациентов с сердечной недостаточностью. Уроки исследования ШАНС. Журнал Сердечная Недостаточность. 2014;15 (6):383–96 [Mareev V. Yu., Begrambekova Yu. L., Danielyan M. O., Ageev F. T., Gilyarevskij S. R., Belenkov Yu. N., Seredenina E. M. Kakie voprosy` zadayutsya i na kakie voprosy` sposobny` otvetit` issledovaniya po nemedikamentoznomu lecheniyu paczientov s serdechnoj nedostatochnost`yu. Uroki issledovaniya ShANS. Zhurnal Serdechnaya Nedostatochnost`. 2014;15 (6):383–96].
  10. Мареев В. Ю., Агеев Ф. Т., Арутюнов Г. П., Коротеев А. В., Ревишвили А. Ш. Национальные рекомендации ВНОК и ОССН по диагностике и лечению Хронической Сердечной Недостаточности (третий пересмотр). Журнал Сердечная Недостаточность. 2009;10 (2):64–106 [Mareev V. Yu., Ageev F. T., Arutyunov G. P., Koroteev A. V., Revishvili A. Sh. Naczional`n y`e rekomendaczii VNOK i OSSN po diagnostike i lecheniyu Xronicheskoj Serdechnoj Nedostatochnosti (tretij peresmotr). Zhurnal Serdechnaya Nedostatochnost`. 2009;10 (2):64–106].
  11. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012 Jul;33 (14):1787–847.
  12. O'Connor CM, Jiang W, Kuchibhatla M, Silva SG, Cuffe MS, Callwood DD et al. Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF trial. J Am Coll Cardiol. 2010 Aug 24;56 (9):692–9.
  13. de la Porte PW, Lok DJ, van Veldhuisen DJ, van Wijngaarden J, Cornel JH, Zuithoff NP et al. Added value of a physician-and nurse directed heart failure clinic: results from the Deventer-Alkmaar failure study. Heart. 2007 Jul;93 (7):819–25.
  14. Clark AM, Thompson DR. The future of management programs for heart failure. Lancet. 2008 Sep 6;372 (9641):784–6.
  15. Angermann CE, Gelbrich G, Störk S, Gunold H, Edelmann F, Wachter R et al. Effect of escitalopram on all-cause mortality and hospitalization in patients with heart failure and depression: the MOOD-HF randomized clinical trial. JAMA. 2016 Jun 28;315(24):2683–93.
  16. Savard LA, Thompson DR, Clark AM. A meta-review of evidence on heart failure disease management programs: the challenges of describing and synthesizing evidence on complex interventions. Trials. 2011 Aug 16;12:194.
  17. Graven LJ, Grant J. The impact of social support on depressive symptoms in individuals with heart failure: update and review. J Cardiovasc Nurs. 2013 Sep-Oct;28 (5):429–43.
  18. Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM et al. HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2010 Jun;16(6):e1–194.
  19. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res. 2002 Feb;52 (2):69–77.
  20. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67 (6):361–70.
  21. Андрюшенко А. В., Дробижев М. Ю., Добровольский А. В. Сравнительная оценка шкал CES-D, BDI и HADS(d) в диагностике депрессий в общемедицинской практике. Журнал неврологии и психиатрии им. С. С. Корсакова. 2003;103 (5):34–9 [Andryushenko A. V., Drobizhev M. Yu., Dobrovol`skij A. V. Sravnitel`naya oczenka shkal CES-D, BDI i HADS (d) v diagnostike depressij v obshhemediczinskoj praktike. Zhurnal nevrologii i psixiatrii im. S. S. Korsakova. 2003;103 (5):34–9].
  22. Bittner V, Weiner DH, Yusuf S, Rogers WJ, McIntyre KM, Bangdiwala SI et al. Prediction of mortality and morbidity with a 6‑minute walk test in patients with left ventricular dysfunction. SOLVD Investigators. JAMA. 1993 Oct 13;270 (14):1702–7.
  23. Forman DE, Fleg JL, Kitzman DW, Brawner CA, Swank AM, McKelvie RS et al. 6‑min walk test provides prognostic utility comparable to cardiopulmonary exercise testing in ambulatory outpatients with systolic heart failure. J Am Coll Cardiol. 2012 Dec 25;60(25):2653–61.
  24. Bellet RN, Adams L, Morris NR. The 6‑minute walk test in outpatient cardiac rehabilitation: validity, reliability and responsiveness – a systematic review. Physiotherapy. 2012 Dec;98 (4):277–86.
  25. Ильина А. В., Мареев В. Ю., Герасимова В. В., Джахангиров Т. Ш., Беленков Ю. Н. Эффективность терапии иАПФ фозиноприлом больных ХСН в сочетании с СД 2 типа (по материалам исследования ФАСОН). Журнал Сердечная Недостаточность. 2005;6 (5):181–6 [Il`ina A. V., Mareev V. Yu., Gerasimova V. V., Dzhaxangirov T. Sh., Belenkov Yu. N. E`ffektivnost` terapii iAPF fozinoprilom bol`ny`x XSN v sochetanii s SD 2 tipa (po materialam issledovaniya FASON). Zhurnal Serdechnaya Nedostatochnost`. 2005;6 (5):181–6].
  26. Мареев В. Ю., Даниелян М. О. Оптимизация применения Беталока-Зок у больных ХСН в повседневной врачебной практике. Дизайн и результаты исследования БЕЗЕ. Журнал Сердечная Недостаточность. 2005;6 (6):251–8 [Mareev V. Yu., Danielyan M. O. Optimizacziya primeneniya Betaloka-Zok u bol`ny`x XSN v povsednevnoj vrachebnoj praktike. Dizajn i rezul`taty` issledovaniya BEZE. Zhurnal Serdechnaya Nedostatochnost`. 2005;6 (6):251–8].
  27. Мареев В. Ю., Выгодин В. А., Беленков Ю. Н. ДиУретическая терапия Эффективными дозами перораЛЬных диуретиков торасемида (Диувер®) и фуросемида в лечении больных с обострением Хронической Сердечной Недостаточности (ДУЭЛЬ–ХСН). Журнал Сердечная Недостаточность. 2011;12 (1):3–10 [Mareev V. Yu., Vy`godin V. A., Belenkov Yu. N. DiUreticheskaya terapiya E`ffektivny`mi dozami peroraL`ny`x diuretikov torasemida (Diuver®) i furosemida v lechenii bol`ny`x s obostreniem Xronicheskoj Serdechnoj Nedostatochnosti (DUE`L`–XSN). Zhurnal Serdechnaya Nedostatochnost`. 2011;12 (1):3–10].
  28. Беграмбекова Ю. Л., Дробижев М. Ю., Мареев В. Ю., Кикта С. В. Можно ли сказать что‑то новое о депрессиях у больных хронической сердечной недостаточностью? Журнал Сердечная Недостаточность. 2015;16 (6):360–7 [Begrambekova Yu. L., Drobizhev M. Yu., Mareev V. Yu., Kikta S. V. Mozhno li skazat` chto-to novoe o depressiyax u bol`ny`x xronicheskoj serdechnoj nedostatochnost`yu? Zhurnal Serdechnaya Nedostatochnost`. 2015;16 (6):360–7].
Begrambekova Yu.L., Mareev V.Yu., Drobizhev M.Yu. Disease management programs for the heart failure patients. Is there any CHANCE to defeat depression and anxiety Post-hoc analysis of CHANCE trial (Congestive Heart Failure: A multidisciplinary Non-pharmacological approach for Changing in rE-hospitalizat. Russian Heart Failure Journal. 2016;17 (6):433–442

To access this material please log in or register

Register Authorize
Ru En