Avash Das1, Bhaskar Roy2, Guido Schwarzer3, Michael G Silverman4, Olivia Ziegler4, Dhrubajyoti Bandyopadhyay5, Lisa Liang Philpotts6, Shirshendu Sinha7, James A Blumenthal8, Saumya Das4. 1. Division of Cardiology, Massachusetts General Hospital, Boston, USA. Electronic address: avash.nrs@gmail.com. 2. Division of Neurology, Yale School of Medicine, Connecticut, USA. 3. Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Germany. 4. Division of Cardiology, Massachusetts General Hospital, Boston, USA. 5. Department of Internal Medicine, St. Luke Roosevelt, Mount Sinai School of Medicine, New York, USA. 6. Treadwell Library, Massachusetts General Hospital, Boston, USA. 7. Department of Psychiatry and Psychology, Mayo Clinic Health System and Mayo Clinic College of Medicine and Science, Mankato, MN, USA. 8. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Abstract
BACKGROUND: Depression independently predicts poor outcomes in heart failure (HF) patients, including increased mortality, morbidity and 30-day re-hospitalization. In this network meta-analysis, we compared different interventions designed to treat depression in HF. MATERIALS AND METHODS: Electronic searches were conducted using Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and PsycINFO up to November 2016. Included randomized clinical trials (RCTs) compared interventions (Exercise therapy (ET), cognitive behavioral therapy (CBT) or antidepressant (AD) medications) for depression in heart failure patients. The primary outcome was change in depressive symptoms based on validated measures of depression. Network meta-analysis based on random effects model estimating standardized mean difference (SMD) with 95% confidence interval (CI), compared the effects of the 3 classes of interventions with respect to usual care or placebo control conditions. RESULTS: A total of 21 RCTs (including 4563 HF patients) reporting the effects of treating depression in HF patients were included in the analysis. In comparison to placebo or usual standard of care, ET (SMD -0.38; 95% CI -0.54 to -0.22) and CBT (SMD -0.29; 95% CI -0.58 to -0.01) were associated with reduction in depressive symptoms whereas AD (SMD -0.16; 95% CI -0.44 to 0.11) was less effective. CONCLUSIONS: This meta-analysis is suggestive of therapeutic benefit of ET and CBT in comparison to usual standard of care in treating depression in HF patients. However, comparison among the three interventions was not conclusive. Future randomized clinical trials are warranted to compare the therapeutic effects of ET, CBT and AD in such patients.
BACKGROUND:Depression independently predicts poor outcomes in heart failure (HF) patients, including increased mortality, morbidity and 30-day re-hospitalization. In this network meta-analysis, we compared different interventions designed to treat depression in HF. MATERIALS AND METHODS: Electronic searches were conducted using Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and PsycINFO up to November 2016. Included randomized clinical trials (RCTs) compared interventions (Exercise therapy (ET), cognitive behavioral therapy (CBT) or antidepressant (AD) medications) for depression in heart failurepatients. The primary outcome was change in depressive symptoms based on validated measures of depression. Network meta-analysis based on random effects model estimating standardized mean difference (SMD) with 95% confidence interval (CI), compared the effects of the 3 classes of interventions with respect to usual care or placebo control conditions. RESULTS: A total of 21 RCTs (including 4563 HF patients) reporting the effects of treating depression in HF patients were included in the analysis. In comparison to placebo or usual standard of care, ET (SMD -0.38; 95% CI -0.54 to -0.22) and CBT (SMD -0.29; 95% CI -0.58 to -0.01) were associated with reduction in depressive symptoms whereas AD (SMD -0.16; 95% CI -0.44 to 0.11) was less effective. CONCLUSIONS: This meta-analysis is suggestive of therapeutic benefit of ET and CBT in comparison to usual standard of care in treating depression in HF patients. However, comparison among the three interventions was not conclusive. Future randomized clinical trials are warranted to compare the therapeutic effects of ET, CBT and AD in such patients.
Authors: Avash Das; Subhajit Dasgupta; Yan Gong; Urvi A Shah; Michael G Fradley; Richard K Cheng; Bhaskar Roy; Avirup Guha Journal: Hematol Oncol Date: 2021-12-30 Impact factor: 4.850
Authors: William V Bobo; Euijung Ryu; Tanya M Petterson; Kandace Lackore; Yijing Cheng; Hongfang Liu; Laura Suarez; Martin Preisig; Leslie T Cooper; Veronique L Roger; Jyotishman Pathak; Alanna M Chamberlain Journal: J Comorb Date: 2020-12-24