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

Aims 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. Methods and 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-