Abstract
This systematic review and meta-analysis aimed to evaluate the effects of cognitive behavioural therapy (CBT) on depression, quality of life, hospitalisations and mortality in heart failure patients. The search strategy was developed for Ovid MEDLINE and modified accordingly to search the following bibliographic databases: PubMed, EMBASE, PsycINFO, CENTRAL and CINAHL. Databases were searched from inception to 6 March 2016 for randomised controlled trials (RCTs) or observational studies that used CBT in heart failure patients with depression or depressive symptoms. Six studies were identified: 5 RCTs and 1 observational study, comprising 320 participants with predominantly NYHA classes II-III, who were mostly male, with mean age ranging from 55 to 66 years. Compared to usual care, CBT was associated with a greater improvement in depression scores both initially after CBT sessions (standardised mean difference −0.34, 95% CI −0.60 to −0.08, p = 0.01) and at 3 months follow-up (standardised mean difference −0.32, 95% CI −0.59 to −0.04, p = 0.03). Greater improvement in quality of life scores was evident for the CBT group initially after CBT sessions, but with no difference at 3 months. Hospital admissions and mortality were similar, regardless of treatment group. CBT may be more effective than usual care at improving depression scores and quality of life for heart failure patients initially following CBT and for depression at 3 months. Larger and more robust RCTs are needed to evaluate the long-term clinical effects of CBT in heart failure patients.
Highlights
Heart failure continues to impose a tremendous burden on patients, carers and healthcare systems
cognitive behavioural therapy (CBT) may be more effective than usual care at improving depression scores and quality of life for heart failure patients initially following CBT and for depression at 3 months
CBT is a wellestablished intervention in depression, and is currently recommended in guidelines [22], but its effectiveness for depression in heart failure patients remains unclear [23]
Summary
Heart failure continues to impose a tremendous burden on patients, carers and healthcare systems. Heart failure is the endpoint of all cardiovascular diseases [3], and the improved survival rates for other cardiovascular diseases are expected to further increase the prevalence, in addition to the increase due to the ageing population [2]. It is a significant cause of mortality, with approximately 5% of all deaths attributable to heart failure in the UK [4], and only 25% of patients are expected to survive beyond 5 years after their first hospital admission [5]—a prognosis that is worse than most cancers [6]. Two percent of all hospitalised bed-days and 5% of all emergency hospital admissions are a result of heart failure [4, 8]
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