Study data published in JAMA Internal Medicine support the efficacy of “blended” care for patients with heart failure (HF) and comorbid depression. In a cohort of patients with both conditions, a collaborative approach to cardiovascular and psychiatric care was found to be associated with improved mental health-related quality of life compared with care as usual. As depression is a common comorbidity with HF, the investigators endorsed the more frequent adaptation of blended care.

This randomized effectiveness trial enrolled patients with HF with reduced left ventricular ejection fraction (<45%) from 8 hospitals in southwestern Pennsylvania. Patients were enrolled between March 2014 and October 2017 and observed until November 2018. Patients were screened for depression during hospitalization for HF and again in the 2 weeks following discharge. Those who were identified as having depression at both screenings were randomly assigned in a 2:2:1 ratio to either (1) collaborative care for HF and depression (“blended” care); (2) collaborative care for HF only (enhanced usual care); or (3) physicians’ usual care. The collaborative care conditions were administered by physician-supervised nursing teams; usual care was administered by physicians only. Briefly, both collaborative care regimens involved frequent follow-up telephone calls to patients to monitor symptoms and provide education. The primary outcome was mental health-related quality of life per the Mental Component Summary of the 12-item Short Form Health Survey (MCS-12). Secondary outcomes included mood, physical function, use of pharmacologic treatment for HF, rehospitalization rate, and mortality. Patients who were found to have depression on screening were also matched 4:1 with randomly sampled patients without depression. Control participants were followed up at 3, 6, and 12 months following discharge for mental health symptoms.

A total of 629 patients with depression and 127 control participants were enrolled in the study. Demographic characteristics were comparable between groups, although patients with depression had lower educational attainment, were more likely to be unemployed, were more likely to report smoking, and were more often White compared with control participants. Additionally, patients with depression had lower health-related quality of life scores compared with control participants. Of the patients with HF and depression, 251 were randomly assigned to blended care, 252 to enhanced usual care, and 126 to usual care.


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At the 12-month follow-up visit, patients assigned to blended care reported a 4.47-point improved MCS-12 score vs those assigned to usual care (95% CI, 1.65-7.28; P =.002). However, improvements in MCS-12 scores were not significantly different between the blended care and enhanced usual care groups (P =.33).

Blended care recipients reported better mood at 12 months compared with usual care recipients and enhanced usual care recipients. However, physical functioning, use of pharmacotherapy for HF, rehospitalization rate, and mortality were comparable between treatment conditions. Secondary outcomes were also not different between the depression and control cohorts.

In this randomized clinical trial of patients with comorbid HF and depression, telephone-based blended care was found to be associated with improvements on the MCS-12 compared with care as usual. However, blended care did not outperform enhanced usual care, nor did it reduce rehospitalization and mortality rates. Even so, a more comprehensive care plan appears to be a cost-effective and patient-accessible option for depression management.

“Despite the modest improvements of telephone-delivered blended collaborative care for HF and depression on clinical outcomes vs physicians’ [usual care] and collaborative care for HF alone in this randomized clinical trial, blended strategies such as ours may enable organized health care systems to provide effective first-line care for comorbid depression and other mental health conditions at scale to medically complex patients,” the investigators wrote.

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Rollman BL, Anderson AM, Rothenberger SD, et al. Efficacy of blended collaborative care for patients with heart failure and comorbid depression: a randomized clinical trial. JAMA Intern Med. Published online August 30, 2021. doi:10.1001/jamainternmed.2021.4978