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Effects of cognitive behavioural therapy for depression in heart failure patients: a systematic review and
Kishaan Jeyanantham1, Dipak Kotecha2,3, Devsaagar Thanki1
1The Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Insights
Cognitive Behavioural Therapy (CBT) significantly improves depression and quality of life in heart failure patients. While initial benefits are clear, long-term effects on hospitalizations and mortality require further investigation.
Area of Science:
- Cardiology
- Psychiatry
- Evidence-Based Medicine
Background:
- Heart failure (HF) patients often experience depression and reduced quality of life (QoL).
- Cognitive Behavioural Therapy (CBT) is a potential intervention to address these psychological comorbidities.
Purpose of the Study:
- To systematically review and meta-analyze the effects of CBT on depression, QoL, hospitalizations, and mortality in patients with heart failure.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies.
- Searched multiple databases (PubMed, EMBASE, PsycINFO, CENTRAL, CINAHL) from inception to March 2016.
- Included 6 studies (5 RCTs, 1 observational) with 320 participants (NYHA classes II-III).
Main Results:
- CBT showed greater improvement in depression scores compared to usual care, both immediately post-intervention (SMD -0.34) and at 3 months (SMD -0.32).
- Quality of life scores improved initially with CBT but showed no significant difference at 3 months.
- Hospital admissions and mortality rates were similar between CBT and usual care groups.
Conclusions:
- CBT appears effective in improving depression and initial quality of life for heart failure patients.
- Further large-scale, robust RCTs are necessary to confirm long-term clinical benefits of CBT in this population.
Abstract:
This systematic review and meta-analysis aimed to evaluate the effects of cognitive behavioural therapy (CBT) on depression, quality of life, hospitalisations and mortality in heart failure patients. The search strategy was developed for Ovid MEDLINE and modified accordingly to search the following bibliographic databases: PubMed, EMBASE, PsycINFO, CENTRAL and CINAHL. Databases were searched from inception to 6 March 2016 for randomised controlled trials (RCTs) or observational studies that used CBT in heart failure patients with depression or depressive symptoms. Six studies were identified: 5 RCTs and 1 observational study, comprising 320 participants with predominantly NYHA classes II-III, who were mostly male, with mean age ranging from 55 to 66 years. Compared to usual care, CBT was associated with a greater improvement in depression scores both initially after CBT sessions (standardised mean difference -0.34, 95% CI -0.60 to -0.08, p = 0.01) and at 3 months follow-up (standardised mean difference -0.32, 95% CI -0.59 to -0.04, p = 0.03). Greater improvement in quality of life scores was evident for the CBT group initially after CBT sessions, but with no difference at 3 months. Hospital admissions and mortality were similar, regardless of treatment group. CBT may be more effective than usual care at improving depression scores and quality of life for heart failure patients initially following CBT and for depression at 3 months. Larger and more robust RCTs are needed to evaluate the long-term clinical effects of CBT in heart failure patients.
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