Depression and the usefulness of a disease management program in heart failure: insights from the COACH (Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure) study.
OBJECTIVE
Our aim was to study the possible role of depressive symptoms in the effectiveness of a disease management program (DMP) in heart failure (HF) patients.


BACKGROUND
Disease management programs are recommended in current HF guidelines, but certain patient groups, such as those with depression, might be less responsive to such programs.


METHODS
From the data of a large multicenter study, in which we examined the effect of a DMP in HF patients, we investigated a potential interaction between depressive symptoms at baseline and the effect of such a program.


RESULTS
Of the 958 HF patients (37% female; age 71 +/- 11 years; New York Heart Association functional class II to IV), 377 (39%) reported depressive symptoms at baseline. During 18 months of follow-up, the primary end point (composite of all-cause mortality and HF readmission) occurred in 39% of the nondepressed patients and 42% of depressed patients. In the overall sample, there was no significant effect of DMP on the composite primary end point. The effect of the DMP was significantly different in nondepressed than in depressed HF patients. A significant effect modification by depressive symptoms was observed in evaluating the effect of the DMP on all-cause mortality and HF readmission (p = 0.03). In patients without depressive symptoms, DMP resulted in a trend for lower incidence of the primary end point (hazard ratio: 0.8, 95% confidence interval: 0.61 to 1.04), whereas the reverse was observed in patients with depressive symptoms (hazard ratio: 1.3, 95% confidence interval: 0.95 to 1.98).


CONCLUSIONS
Depressive symptoms in patients with HF have a major effect on the usefulness of DMP. Identification of depressive symptoms before enrollment in a DMP might lead to more accurate use of a DMP, because depressive patients might not benefit from a general program. (Netherlands Heart Foundation Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure; ISRCTN98675639).
Jaarsma
Tiny
T
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. t.jaarsma@thorax.umcg.nl
Lesman-Leegte
Ivonne
I
Hillege
Hans L
HL
Veeger
Nic J
NJ
Sanderman
Robbert
R
van Veldhuisen
Dirk J
DJ
D000368:Aged; D003863:Depression / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D008297:Male