Johanna Koehler1,2, Andreas Stengel3,4, Tobias Hofmann3, Karl Wegscheider5, Kerstin Koehler1, Susanne Sehner5, Matthias Rose3, Oliver Deckwart1, Stefan D Anker6,7, Friedrich Koehler1, Ulrich Laufs8. 1. Charité - Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany. 2. Universität Leipzig - Faculty of Medicine, Leipzig, Germany. 3. Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine; Charité Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany. 4. Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany. 5. Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany. 6. Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany. 7. Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany. 8. Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany.
Abstract
AIMS: Depression is a frequent comorbidity in patients with chronic heart failure (CHF). Telemonitoring has emerged as a novel option in CHF care. However, patients with depression have been excluded in most telemedicine studies. This pre-specified subgroup analysis of the Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial investigates the effect of telemonitoring on depressive symptoms over a period of 12 months. METHODS AND RESULTS: The TIM-HF study randomly assigned 710 patients withCHF to either usual care (UC) or a telemedical intervention (TM) using non-invasive devices for daily monitoring electrocardiogram, blood pressure and body weight. Depression was evaluated by the 9-item Patient Health Questionnaire (PHQ-9) with scores ≥10 defining clinically relevant depressive symptoms. Mixed model repeated measures were performed to calculate changes in PHQ-9 score. Quality of life was measured by the Short Form-36. At baseline, 156 patients had a PHQ-9 score ≥10 points (TM: 79, UC: 77) with a mean of 13.2 points indicating moderate depressiveness. Patients randomized to telemedicine showed an improvement of their PHQ-9 scores, whereas UC patients remained constant (P = 0.004). Quality of life parameters were improved in the TM group compared to UC. Adjustment was performed for follow-up, New York Heart Association class, medication, age, current living status, number of hospitalizations within the last 12 months and serum creatinine. In the study population without depression, the PHQ-9 score was similar at baseline and follow-up. CONCLUSION: Telemedical care improved depressive symptoms and had a positive influence on quality of life in patients with CHF and moderate depression.
RCT Entities:
AIMS: Depression is a frequent comorbidity in patients with chronic heart failure (CHF). Telemonitoring has emerged as a novel option in CHF care. However, patients with depression have been excluded in most telemedicine studies. This pre-specified subgroup analysis of the Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial investigates the effect of telemonitoring on depressive symptoms over a period of 12 months. METHODS AND RESULTS: The TIM-HF study randomly assigned 710 patients with CHF to either usual care (UC) or a telemedical intervention (TM) using non-invasive devices for daily monitoring electrocardiogram, blood pressure and body weight. Depression was evaluated by the 9-item Patient Health Questionnaire (PHQ-9) with scores ≥10 defining clinically relevant depressive symptoms. Mixed model repeated measures were performed to calculate changes in PHQ-9 score. Quality of life was measured by the Short Form-36. At baseline, 156 patients had a PHQ-9 score ≥10 points (TM: 79, UC: 77) with a mean of 13.2 points indicating moderate depressiveness. Patients randomized to telemedicine showed an improvement of their PHQ-9 scores, whereas UC patients remained constant (P = 0.004). Quality of life parameters were improved in the TM group compared to UC. Adjustment was performed for follow-up, New York Heart Association class, medication, age, current living status, number of hospitalizations within the last 12 months and serum creatinine. In the study population without depression, the PHQ-9 score was similar at baseline and follow-up. CONCLUSION: Telemedical care improved depressive symptoms and had a positive influence on quality of life in patients with CHF and moderate depression.
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