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Cognitive behavioral therapy for depression in patients with heart failure: a systematic review and metanalysis of randomized control trials

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Abstract

Major depression (MD) is prevalent in patients with heart failure (HF) and contributes to increased risk of hospitalization and mortality. The implementation of cognitive behavioral therapy (CBT) has become a key strategy for treating HF patients' depression. We performed a comprehensive literature search for studies that evaluated the efficacy of adjunctive CBT compared to the standard of care (SOC) in HF patients with MD. The primary outcome was the depression scale (post-intervention and by the end of follow-up). The secondary outcomes were the quality of life (QoL), self-care scores, and 6-min walk test distance(6-MW). The standardized mean difference (SMD) and corresponding 95% confidence intervals (CIs) were calculated using the random-effects model. A total of 6 RCTs with 489 patients (244 in the CBT group and 245 in the SOC group) were included. As compared to the SOC, CBT was associated with a statistically significant improvement in the post-interventional depression scale (SMD: -0.45, 95%CI: -0.69, -0.21; P < 0.01) and by the end of follow-up (SMD: -0.68, 95%CI: -0.87, -0.49; P < 0.01). Furthermore, CBT significantly improved the QoL (SMD: -0.45, 95%CI: -0.65, -0.24; P < 0.01). However, there were no differences in the self-care scores (SMD: 0.17, 95%CI: -0.08, 0.42; P = 0.18) or in 6-MW (SMD: 0.45, 95%CI: -0.39, 1.28; P = 0.29) between the two groups. According to our meta-analysis of published clinical studies, CBT may be more effective than standard therapy at enhancing depression scores and quality of life. To assess the long-term clinical effects of CBT in heart failure patients, larger and more powerful RCTs are required.

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Abbreviations

MD:

Major depression

HF:

Heart failure

CBT:

Cognitive behavioral therapy

SOC:

Standard of care

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Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of Iowa, 200 Hawkins Dr, E 315GH, Iowa City, USA

    Mohammed Mhanna & Shareef Mansour

  2. Department of Medicine, University of Iowa, Iowa City, Iowa, USA

    Michael C. Sauer

  3. Department of Internal Medicine, University of Kentucky, Lexington, KY, USA

    Ahmad Al-Abdouh

  4. Department of Cardiology, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH, USA

    Ahmad Jabri

  5. Division of Cardiology, Creighton University, Omaha, NE, USA

    Waiel Abusnina

  6. Department of Internal Medicine, The University of Toledo, Toledo, OH, USA

    Mohammed Safi

  7. Department of Gastroenterology, Indiana University, Indianapolis, IN, USA

    Azizullah Beran

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  1. Mohammed Mhanna
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  2. Michael C. Sauer
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  4. Ahmad Jabri
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  8. Shareef Mansour
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Contributions

MM and AA conceived and designed the study, drafted the manuscript, and critically revised the manuscript. MM, AJ, and WA designed the study, and collected, analyzed, and interpreted the data. MCS, MS, AB, and SM collected the data and reviewed the literature. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mohammed Mhanna.

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No ethical approval was needed.

IRB Approval

This study was deemed exempt by the Institutional Review Board of the University of Iowa, as it was a meta-analysis of published studies that included de-identified patient information.

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The authors declared no conflict of interest.

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Mhanna, M., Sauer, M.C., Al-Abdouh, A. et al. Cognitive behavioral therapy for depression in patients with heart failure: a systematic review and metanalysis of randomized control trials. Heart Fail Rev 28, 1091–1100 (2023). https://doi.org/10.1007/s10741-023-10308-3

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  • DOI: https://doi.org/10.1007/s10741-023-10308-3

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