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Rajasree Katta M, Prasad S, Tiwari A, Abdelgawad Abouzid MR, Mitra S. The effectiveness of cognitive-behavioral therapy for heart failure patients: a narrative review. J Int Med Res 2023; 51:3000605231198371. [PMID: 37694958 PMCID: PMC10498714 DOI: 10.1177/03000605231198371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Heart failure (HF) remains a major cause of morbidity, mortality and healthcare costs, despite available treatments. Psychological issues such as depression, anxiety and poor self-care are prevalent in HF patients. Such issues adversely affect patients' daily lives and increase hospitalization and mortality rates; therefore, effective approaches to address these are needed. Cognitive-behavioral therapy (CBT) has been proposed as potentially useful for psychological comorbidities in HF patients, but its efficacy is not well-established. This narrative review aimed to summarize the evidence on the effectiveness of CBT for HF patients. A search was conducted using PubMed and Google Scholar for randomized controlled trials (RCTs) on CBT for HF patients. Ten studies (nine RCTs and one case study) were included in the review. CBT was found to be an effective intervention for managing depression, anxiety, low quality of life, and impaired social and physical functioning in HF patients. The results suggest that CBT can improve psychological well-being and enhance the benefits of rehabilitation programs. Face-to-face CBT appears to be superior to conventional therapy and can be implemented in cardiac rehabilitation settings. Further research is needed to evaluate the efficacy of internet-based CBT for cardiac patients and identify factors that promote treatment adherence.
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Affiliation(s)
| | - Sakshi Prasad
- Faculty of Medicine, Vinnytsia National Medical University, Vinnytsya, Ukraine
| | - Atit Tiwari
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Saloni Mitra
- Bogomolets National Medical University, Kyiv, Ukraine
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Clays E, Puddu PE, Luštrek M, Pioggia G, Derboven J, Vrana M, De Sutter J, Le Donne R, Baert A, Bohanec M, Ciancarelli MC, Dawodu AA, De Pauw M, De Smedt D, Marino F, Pardaens S, Schiariti MS, Valič J, Vanderheyden M, Vodopija A, Tartarisco G. Proof-of-concept trial results of the HeartMan mobile personal health system for self-management in congestive heart failure. Sci Rep 2021; 11:5663. [PMID: 33707523 PMCID: PMC7970991 DOI: 10.1038/s41598-021-84920-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 02/10/2021] [Indexed: 12/28/2022] Open
Abstract
This study tested the effectiveness of HeartMan-a mobile personal health system offering decisional support for management of congestive heart failure (CHF)-on health-related quality of life (HRQoL), self-management, exercise capacity, illness perception, mental and sexual health. A randomized controlled proof-of-concept trial (1:2 ratio of control:intervention) was set up with ambulatory CHF patients in stable condition in Belgium and Italy. Data were collected by means of a 6-min walking test and a number of standardized questionnaire instruments. A total of 56 (34 intervention and 22 control group) participants completed the study (77% male; mean age 63 years, sd 10.5). All depression and anxiety dimensions decreased in the intervention group (p < 0.001), while the need for sexual counselling decreased in the control group (p < 0.05). Although the group differences were not significant, self-care increased (p < 0.05), and sexual problems decreased (p < 0.05) in the intervention group only. No significant intervention effects were observed for HRQoL, self-care confidence, illness perception and exercise capacity. Overall, results of this proof-of-concept trial suggest that the HeartMan personal health system significantly improved mental and sexual health and self-care behaviour in CHF patients. These observations were in contrast to the lack of intervention effects on HRQoL, illness perception and exercise capacity.
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Affiliation(s)
- Els Clays
- Department of Public Health and Primary Care, Ghent University, Campus University Hospital Ghent, entrance 42, 4K3, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Paolo Emilio Puddu
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Mitja Luštrek
- Department of Intelligent Systems, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation, Italian National Research Council, Messina, Italy
| | - Jan Derboven
- Meaningful Interactions Lab, KU Leuven, Leuven, Belgium
| | | | - Johan De Sutter
- Department of Cardiology, AZ Maria Middelares Ghent, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Rita Le Donne
- Complex Operative Unit of Pneumology and Telemedicine, San Camillo de Lellis General Hospital, Rieti, Italy
| | - Anneleen Baert
- Department of Public Health and Primary Care, Ghent University, Campus University Hospital Ghent, entrance 42, 4K3, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Marko Bohanec
- Department of Knowledge Technologies, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Maria Costanza Ciancarelli
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.,Complex Operative Unit of Pneumology and Telemedicine, San Camillo de Lellis General Hospital, Rieti, Italy
| | - Amos Adeyemo Dawodu
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.,Complex Operative Unit of Pneumology and Telemedicine, San Camillo de Lellis General Hospital, Rieti, Italy
| | - Michel De Pauw
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Campus University Hospital Ghent, entrance 42, 4K3, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Flavia Marino
- Institute for Biomedical Research and Innovation, Italian National Research Council, Messina, Italy
| | - Sofie Pardaens
- Cardiovascular Center, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium
| | - Michele Salvatore Schiariti
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Jakob Valič
- Department of Intelligent Systems, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Marc Vanderheyden
- Cardiovascular Center, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium
| | - Aljoša Vodopija
- Department of Intelligent Systems, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Gennaro Tartarisco
- Institute for Biomedical Research and Innovation, Italian National Research Council, Messina, Italy
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Chew HSJ, Cheng HY, Chair SY. The suitability of motivational interviewing versus cognitive behavioural interventions on improving self-care in patients with heart failure: A literature review and discussion paper. Appl Nurs Res 2018; 45:17-22. [PMID: 30683246 DOI: 10.1016/j.apnr.2018.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Chronic heart failure remains a major public health concern due to its high prevalence and disease burden. Although self-care has been advocated as the sustainable solution, it remains inadequate. Recent studies have shown the potential of integrating structured counselling elements into traditional educational programs to enhance self-care but the optimal counselling method remains unclear. AIM To compare the applicability of cognitive behavioural interventions and motivational interviewing on improving self-care behaviours in patients with chronic heart failure. METHOD A systematic three-step search strategy was used to identify studies that incorporated cognitive behavioural interventions and/or motivational interviewing to improve heart failure self-care. Quantitative and qualitative trial studies that met the inclusion criteria were appraised using the Joanna Brigg's Institute criteria. RESULTS Motivational interviewing showed higher potential in improving HF self-care behaviours, but sustainability remains unclear. Cognitive behavioural interventions only showed effectiveness when applied to patients with comorbid depressive symptoms. Statistically significant results were only elucidated upon statistical adjustments and examination of behaviours individually. Potential effective components of CBI include setting up environmental reminders, addressing misconceptions and skills-training while that of MI was the communication style. CONCLUSION MI and CBI could be used synergistically by extracting their key effective components to strengthen the intention-behaviour link in improving HF self-care behaviours. MI could be used to enhance the intention to change by evoking ambivalence and change talk. CBI could be used to enhance problem-solving skills and set environmental reminders to strengthen the translation of intention to behaviour.
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Affiliation(s)
- Han Shi Jocelyn Chew
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Ho Yu Cheng
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Sek Ying Chair
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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4
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Effectiveness of Cognitive Behavioral Therapy for Depression and Anxiety in Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis. Psychosom Med 2018; 80:742-753. [PMID: 30281027 DOI: 10.1097/psy.0000000000000626] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Depression and anxiety are highly prevalent in patients with cardiovascular disease (CVD) and influence their mental well-being and CVD prognosis. The primary objective was to assess the effectiveness of cognitive behavioral therapy (CBT) for depression and anxiety in patients with CVD. Secondary objectives were to assess the impact of CBT on cardiovascular mortality, cardiovascular events, patient satisfaction, and quality of life. METHODS MEDLINE, PsycINFO, CINAHL, CENTRAL, and alternative sources were searched for randomized controlled trials and observational studies with a control. Studies were required to assess CBT in coronary heart disease, acute coronary syndrome, atrial fibrillation, or postmyocardial infarction patients, with anxiety and/or depression. Studies were independently screened by two reviewers and critically appraised using the Cochrane Risk of Bias tool. The random-effects model was used to pool standardized mean differences (SMD). RESULTS Twelve randomized controlled trials were included. At follow-up, depression (SMD = -0.35, 95% confidence interval [CI] = -0.52 to -0.17, p < .001, I = 59%) and anxiety (SMD = -0.34, 95% CI = -0.65 to -0.03, p = .03, I = 71%) scores were significantly lower in CBT patients compared with controls. Change in mental health quality of life (SF-12) was also significantly greater for CBT patients, compared with controls (mean difference = 3.62, 95% CI = 0.22 to 7.02, p = .04, I = 0%). No differences in patient satisfaction or cardiovascular events were evident between CBT and control groups. Among the study reports included in this meta-analysis, data specific to cardiovascular mortality were not reported. CONCLUSIONS Cognitive behavioral therapy seems to be an effective treatment for reducing depression and anxiety in patients with CVD and should be considered in standard clinical care.
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Lundgren J, Johansson P, Jaarsma T, Andersson G, Kärner Köhler A. Patient Experiences of Web-Based Cognitive Behavioral Therapy for Heart Failure and Depression: Qualitative Study. J Med Internet Res 2018; 20:e10302. [PMID: 30185405 PMCID: PMC6231888 DOI: 10.2196/10302] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/14/2018] [Accepted: 06/25/2018] [Indexed: 12/28/2022] Open
Abstract
Background Web-based cognitive behavioral therapy (wCBT) has been proposed as a possible treatment for patients with heart failure and depressive symptoms. Depressive symptoms are common in patients with heart failure and such symptoms are known to significantly worsen their health. Although there are promising results on the effect of wCBT, there is a knowledge gap regarding how persons with chronic heart failure and depressive symptoms experience wCBT. Objective The aim of this study was to explore and describe the experiences of participating and receiving health care through a wCBT intervention among persons with heart failure and depressive symptoms. Methods In this qualitative, inductive, exploratory, and descriptive study, participants with experiences of a wCBT program were interviewed. The participants were included through purposeful sampling among participants previously included in a quantitative study on wCBT. Overall, 13 participants consented to take part in this study and were interviewed via telephone using an interview guide. Verbatim transcripts from the interviews were qualitatively analyzed following the recommendations discussed by Patton in Qualitative Research & Evaluation Methods: Integrating Theory and Practice. After coding each interview, codes were formed into categories. Results Overall, six categories were identified during the analysis process. They were as follows: “Something other than usual health care,” “Relevance and recognition,” “Flexible, understandable, and safe,” “Technical problems,” “Improvements by real-time contact,” and “Managing my life better.” One central and common pattern in the findings was that participants experienced the wCBT program as something they did themselves and many participants described the program as a form of self-care. Conclusions Persons with heart failure and depressive symptoms described wCBT as challenging. This was due to participants balancing the urge for real-time contact with perceived anonymity and not postponing the work with the program. wCBT appears to be a valuable tool for managing depressive symptoms.
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Affiliation(s)
- Johan Lundgren
- Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Peter Johansson
- Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Tiny Jaarsma
- Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.,Mary Mackillop Institute, Australian Catholic University, Melbourne, Australia
| | - Gerhard Andersson
- Division of Psychology, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Anita Kärner Köhler
- Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
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Alpert CM, Smith MA, Hummel SL, Hummel EK. Symptom burden in heart failure: assessment, impact on outcomes, and management. Heart Fail Rev 2018; 22:25-39. [PMID: 27592330 DOI: 10.1007/s10741-016-9581-4] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Evidence-based management has improved long-term survival in patients with heart failure (HF). However, an unintended consequence of increased longevity is that patients with HF are exposed to a greater symptom burden over time. In addition to classic symptoms such as dyspnea and edema, patients with HF frequently suffer additional symptoms such as pain, depression, gastrointestinal distress, and fatigue. In addition to obvious effects on quality of life, untreated symptoms increase clinical events including emergency department visits, hospitalizations, and long-term mortality in a dose-dependent fashion. Symptom management in patients with HF consists of two key components: comprehensive symptom assessment and sufficient knowledge of available approaches to alleviate the symptoms. Successful treatment addresses not just the physical but also the emotional, social, and spiritual aspects of suffering. Despite a lack of formal experience during cardiovascular training, symptom management in HF can be learned and implemented effectively by cardiology providers. Co-management with palliative medicine specialists can add significant value across the spectrum and throughout the course of HF.
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Affiliation(s)
- Craig M Alpert
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael A Smith
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA.,Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA
| | - Scott L Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Ellen K Hummel
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA. .,University of Michigan Frankel Cardiovascular Center, 1500 East Medical Center Dr., SPC 5233, Ann Arbor, MI, 48109-5233, USA.
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Lundgren JG, Dahlström Ö, Andersson G, Jaarsma T, Kärner Köhler A, Johansson P. The Effect of Guided Web-Based Cognitive Behavioral Therapy on Patients With Depressive Symptoms and Heart Failure: A Pilot Randomized Controlled Trial. J Med Internet Res 2016; 18:e194. [PMID: 27489077 PMCID: PMC5070581 DOI: 10.2196/jmir.5556] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 06/12/2016] [Accepted: 06/17/2016] [Indexed: 12/21/2022] Open
Abstract
Background Depressive symptoms, and the associated coexistence of symptoms of anxiety and decreased quality of life (QoL), are common in patients with heart failure (HF). However, treatment strategies for depressive symptoms in patients with HF still remain to be established. Internet-based cognitive behavioral therapy (ICBT), as guided self-help CBT programs, has shown good effects in the treatment of depression. Until now, ICBT has not been evaluated in patients with HF with depressive symptoms. Objective The aims of this study were to (1) evaluate the effect of a 9-week guided ICBT program on depressive symptoms in patients with HF; (2) investigate the effect of the ICBT program on cardiac anxiety and QoL; and (3) assess factors associated with the change in depressive symptoms. Methods Fifty participants were randomized into 2 treatment arms: ICBT or a Web-based moderated discussion forum (DF). The Patient Health Questionnaire-9 was used to measure depressive symptoms, the Cardiac Anxiety Questionnaire (CAQ) was used to measure cardiac-related anxiety, and the Minnesota Living with Heart Failure questionnaire was used to measure QoL. Data were collected at baseline and at follow-up at the end of the 9-week intervention. Intention-to-treat analysis was used, and missing data were imputed by the Expectation-Maximization method. Between-group differences were determined by analysis of covariance with control for baseline score and regression to the mean. Results No significant difference in depressive symptoms between the ICBT and the DF group at the follow-up was found, [F(1,47)=1.63, P=.21] and Cohen´s d=0.26. Secondary within-group analysis of depressive symptoms showed that such symptoms decreased significantly in the ICBT group from baseline to the follow-up (baseline M=10.8, standard deviation [SD]=5.7 vs follow-up M=8.6, SD=4.6, t(24)=2.6, P=.02, Cohen´s d=0.43), whereas in the DF group, there was no significant change (baseline M=10.6, SD=5.0, vs follow-up M=9.8, SD=4.3, t(24)=0.93, P=.36. Cohen´s d=0.18). With regard to CAQ and QoL no significant differences were found between the groups (CAQ [d(1,47)=0.5, P=.48] and QoL [F(1,47)=2.87, P=.09]). In the ICBT group in the CAQ subscale of fear, a significant within-group decrease was shown (baseline M=1.55 vs follow-up M=1.35, P=.04). In the ICBT group, the number of logins to the Web portal correlated significantly with improvement in depressive symptoms (P=.02), whereas higher age (P=.01) and male sex (P=.048) were associated with less change in depressive symptoms. This study is underpowered because of difficulties in the recruitment of patients. Conclusions Guided ICBT adapted for persons with HF and depressive symptoms was not statistically superior to participation in a Web-based DF. However, within the ICBT group, a statically significant improvement of depressive symptoms was detected. ClinicalTrial Clinicaltrials.gov NCT01681771; https://clinicaltrials.gov/ct2/show/NCT01681771 (Archived by WebCite at http://www.webcitation.org/6ikzbcuLN)
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Affiliation(s)
- Johan Gustav Lundgren
- Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
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Versteeg H, Denollet J, Meine M, Pedersen SS. Patient-reported health status prior to cardiac resynchronisation therapy identifies patients at risk for poor survival and prolonged hospital stays. Neth Heart J 2015; 24:18-24. [PMID: 26645709 PMCID: PMC4692829 DOI: 10.1007/s12471-015-0775-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Patient-reported factors have largely been neglected in search of predictors of response to cardiac resynchronisation therapy (CRT). The current study aimed to examine the independent value of pre-implantation patient-reported health status in predicting four-year survival and cardiac-related hospitalisation of CRT patients. Methods Consecutive patients (N = 139) indicated to receive a first-time CRT-defibrillator at the University Medical Center Utrecht were asked to complete a set of questionnaires prior to implantation. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess heart failure-specific health status. Data on patients’ demographic, clinical and psychological characteristics at baseline, and on cardiac-related hospitalisations and all-cause deaths during a median follow-up of 3.9 years were obtained from purpose-designed questionnaires and patients’ medical records. Results Results of multivariable Cox regression analyses showed that poor patient-reported health status (KCCQ score < 50) prior to implantation was associated with a 2.5-fold increased risk of cardiac hospitalisation or all-cause death, independent of sociodemographic, clinical and psychological risk factors (adjusted hazard ratio 2.46, 95 % confidence interval (CI) 1.30–4.65). Poor health status was not significantly associated with the absolute number of cardiac-related hospital admissions, but with the total number of days spent in hospital during follow-up (adjusted incidence rate ratio 3.20, 95 % CI 1.88–5.44). Conclusions Patient-reported health status assessed prior to CRT identifies patients at risk for poor survival and prolonged hospital stays, independent of traditional risk factors. These results emphasise the importance of incorporating health status measures in cardiovascular research and patient management. Heart failure patients reporting poor health status should be identified and offered appropriate additional treatment programs.
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Affiliation(s)
- H Versteeg
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
| | - J Denollet
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
| | - M Meine
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - S S Pedersen
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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9
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Lundgren J, Andersson G, Dahlström Ö, Jaarsma T, Köhler AK, Johansson P. Internet-based cognitive behavior therapy for patients with heart failure and depressive symptoms: A proof of concept study. PATIENT EDUCATION AND COUNSELING 2015; 98:935-942. [PMID: 25990216 DOI: 10.1016/j.pec.2015.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/16/2015] [Accepted: 04/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim was (1) to describe the development of a guided internet-based CBT (ICBT) program adapted to patients with heart failure (HF) and (2) to evaluate the feasibility of the ICBT program in regard to depressive symptoms, the time used by health care providers to give feedback, and participants' perceptions of the ICBT program. METHOD A multi-professional team developed the program and seven HF patients with depressive symptoms were recruited to the study. The Patient Health Questionnaire-9 (PHQ-9) and the Montgomery Åsberg Depression Rating-Self-rating scale (MADRS-S) were used to measure depression, and patients were interviewed about their perceptions of the program. RESULTS Based on research in HF and CBT, a nine-week program was developed. The median depression score decreased from baseline to the end of the study (PHQ-9: 11-8.5; MADRS-S: 25.5-16.5) and none of the depression scores worsened. Feedback from health care providers required approximately 3h per patient. Facilitating perceptions (e.g. freedom of time) and demanding perceptions (e.g. part of the program demanded a lot of work) were described by the patients. CONCLUSION The program appears feasible and time-efficient. However, the program needs to be evaluated in a larger randomized study.
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Affiliation(s)
- Johan Lundgren
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
| | - Örjan Dahlström
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
| | - Anita Kärner Köhler
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
| | - Peter Johansson
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden; Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
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LeMond L, Goodlin SJ. Management of Heart Failure in Patients Nearing the End of Life-There is So Much More To Do. Card Fail Rev 2015; 1:31-34. [PMID: 28785428 DOI: 10.15420/cfr.2015.01.01.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
As the population of patients living with heart failure increases, the number of patients who will die with and from heart failure increases as well. End-of-life care in patients with heart failure is an additive process, whereby therapies to treat symptoms not alleviated by guideline-based medical therapy are integrated into the care of these individuals. This review focuses on providing clinicians with a basic framework for administration of end-of-life care in patients with heart failure, specifically focusing on decision-making, symptom management and functional management.
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Affiliation(s)
- Lisa LeMond
- Knight Cardiovascular Institute, Oregon Health and Science University,Portland, Oregon, US
| | - Sarah J Goodlin
- Oregon Health and Sciences University and the Portland VAMC,Portland, Oregon, US
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