title: Effects of structured heart failure disease management on mortality and morbidity depend on patients' mood: results from the Interdisciplinary Network for Heart Failure Study.
abstract: OBJECTIVE
  Depression is common in heart failure (HF) and associated with adverse outcomes. Randomized comparisons of the effectiveness of HF care strategies by patients' mood are scarce. We therefore investigated in a randomized trial a structured collaborative disease management programme (HeartNetCare-HF™; HNC) recording mortality, morbidity, and symptoms in patients enrolled after hospitalization for decompensated systolic HF according to their responses to the 9-item Patient Health Questionnaire (PHQ-9) during an observation period of 180 days.
  
  
  RESULTS
  Subjects scoring <12/≥12 were categorized as non-depressed/depressed, and those ignoring the questionnaire as PHQ-deniers. Amongst 715 participants (69 ± 12 years, 29% female), 141 (20%) were depressed, 466 (65%) non-depressed, and 108 (15%) PHQ-deniers. The composite endpoint of mortality and re-hospitalization was neutral overall and in all subgroups. However, HNC reduced mortality risk in both depressed and non-depressed patients [adjusted hazard ratios (HRs) 0.12, 95% confidence interval (CI) 0.03-0.56, P = 0.006, and 0.49, 95% CI 0.25-0.93, P = 0.03, respectively], but not in PHQ-deniers (HR 1.74, 95% CI 0.77-3.96, P = 0.19; P = 0.006 for homogeneity of HRs). Average frequencies of patient contacts in the HNC arm were 12.8 ± 7.9 in non-depressed patients, 12.4 ± 7.1 in depressed patients, and 5.5 ± 7.2 in PHQ-deniers (P < 0.001).
  
  
  CONCLUSIONS
  Early after decompensation, HNC reduced mortality risk in non-depressed and even more in depressed subjects, but not in PHQ-deniers. This suggests that differential acceptability and chance of success of care strategies such as HNC might be predicted by appropriate assessment of patients' baseline characteristics including psychological disposition. These post-hoc results should be reassessed by prospective evaluation of HNC in larger HF populations.
authors.affiliation: University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Götz
authors.initials: G
authors.lastname: Gelbrich
authors.forename: Stefan
authors.initials: S
authors.lastname: Störk
authors.forename: Sonja
authors.initials: S
authors.lastname: Kreißl-Kemmer
authors.forename: Hermann
authors.initials: H
authors.lastname: Faller
authors.forename: Christiane
authors.initials: C
authors.lastname: Prettin
authors.forename: Peter U
authors.initials: PU
authors.lastname: Heuschmann
authors.forename: Georg
authors.initials: G
authors.lastname: Ertl
authors.forename: Christiane E
authors.initials: CE
authors.lastname: Angermann
mesh_terms: D000368:Aged; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000523:psychology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016019:Survival Analysis
keywords: Depression; Disease management; Heart failure; Morbidity; Mortality