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PubMed · 42532282

Psychotherapy vs antidepressants in heart failure: Impact of adherence.

Waguih William IsHak·Michele A Hamilton·Marcio A Diniz·James Mirocha·Robert Chernoff·Rebecca Hedrick·Harriet Aronow·Tarneem Darwish·Gabrielle Messineo·Mia Pasini·Linda Olanisa·Ella Tetrault·Ankith Arun·Kaleab K Tessema·John Gordon Harold·Michael K Ong·Brennan Spiegel·Kenneth Wells·Itai Danovitch
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Abstract

BACKGROUND: Depression affects nearly half of patients with heart failure (HF), which is associated with increased morbidity and reduced health-related quality of life (HRQoL). This secondary per-protocol analysis of a previously published randomized trial evaluated the behavioral activation (BA) versus antidepressant medication (MEDS) among patients with depression and HF who adhered to study interventions. METHODS: This analysis is based on a pragmatic randomized comparative-effectiveness trial conducted from 2018 to 2022, with a 1-year follow-up. 416 participants diagnosed with HF and a DSM-5 depressive disorder were randomized to BA or MEDS, and the current analysis examined outcomes according to treatment adherence. OUTCOMES: The primary outcome was depressive symptom severity (PHQ-9) at 6&#xa0;months, and the secondary outcomes were physical and mental HRQoL (SF-12v2-PC and SF-12v2-MC, respectively) and HF-specific HRQoL (Kansas City Cardiomyopathy Questionnaire; KCCQ) overall and clinical scores (KCCQ-OS and KCCQ-CS), at 3, 6, and 12&#xa0;months. High adherence was defined as completion of >75-100% of intervention components. Overall adherence rates were similar between BA and MEDS. At 6&#xa0;months, among patients with >75-100% adherence who followed treatment as directed in both arms, BA was associated with higher Mental HRQoL (SF-12v2-MC: 5.22; 95% CI: 0.72 to 9.72; p&#xa0;=&#xa0;0.023) and higher HF-specific HRQoL (KCCQ-OS: 16.08; 95% CI: 7.20 to 24.97; p&#xa0;<&#xa0;0.001); (KCCQ-CS: 16.04; 95%CI: 7.05 to 25.02; p&#xa0;<&#xa0;0.001) compared to MEDS. There were no significant differences in depressive symptoms or physical HRQoL at 6&#xa0;months. INTERPRETATION: Both BA and MEDS were equally effective treatments for depression in HF. However, among highly adherent patients, BA was associated with greater improvements in mental and HF-specific HRQoL than MEDS. FUNDING/SUPPORT: The study was funded by PCORI Award Number: 2017C2-7716.

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HumansHeart FailureAntidepressive AgentsFemaleQuality of LifeMaleMiddle AgedAgedDepressive DisorderPsychotherapyAntidepressant therapyBehavioral activationDepressionHeart failureRandomized controlled trialTreatment adherenceJournal ArticleRandomized Controlled TrialPragmatic Clinical TrialComparative Study

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Waguih William IsHak, Michele A Hamilton, Marcio A Diniz, James Mirocha, Robert Chernoff, Rebecca Hedrick, Harriet Aronow, Tarneem Darwish, Gabrielle Messineo, Mia Pasini, Linda Olanisa, Ella Tetrault, Ankith Arun, Kaleab K Tessema, John Gordon Harold, Michael K Ong, Brennan Spiegel, Kenneth Wells, Itai Danovitch. 2026-07-30. Psychotherapy vs antidepressants in heart failure: Impact of adherence.. https://doi.org/10.1016/j.jad.2026.122318

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Aged subjectAntidepressant therapy subjectAntidepressive Agents subjectBehavioral activation subjectComparative Study subjectDepression subjectDepressive Disorder subjectFemale subjectHeart Failure subjectHumans subjectJournal Article subjectJournal Article; Randomized Controlled Trial; Pragmatic Clinical Trial; Comparative Study resourceMale subjectMiddle Aged subjectRandomized controlled trials study

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