Department of Psychiatry (K.E.F., J.A.S., R.M.C., B.C.S., E.H.R.), Washington University School of Medicine, St. Louis, MO.
Cardiovascular Division of the Department of Internal Medicine (M.W.R.), Washington University School of Medicine, St. Louis, MO.
Circ Heart Fail. 2022 Aug;15(8):e009422. doi: 10.1161/CIRCHEARTFAILURE.121.009422. Epub 2022 Jun 21.
Major depression and inadequate self-care are common in patients with heart failure (HF). Little is known about how to intervene when both problems are present. This study examined the efficacy of a sequential approach to treating these problems.
Stepped Care for Depression in HF was a single-site, single-blind, randomized controlled trial of cognitive behavior therapy (CBT) versus usual care (UC) for major depression in patients with HF. The intensive phase of the CBT intervention lasted between 8 and 16 weeks, depending upon the rate of improvement in depression. All participants received a tailored HF self-care intervention that began 8 weeks after randomization. The intensive phase of the self-care intervention ended at 16 weeks post-randomization. The coprimary outcome measures were the Beck Depression Inventory (version 2) and the Maintenance scale of the Self-Care of HF Index (v6.2) at week 16.
One hundred thirty-nine patients with HF and major depression were enrolled; 70 were randomized to UC and 69 to CBT. At week 16, the patients in the CBT arm scored 4.0 points ([95% CI, -7.3 to -0.8]; =0.02) lower on the Beck Depression Inventory, version 2 than those in the usual care arm. Mean scores on the Self-Care of HF Index Maintenance scale were not significantly different between the groups ([95% CI, -6.5 to 1.5]; =0.22).
CBT is more effective than usual care for major depression in patients with HF. However, initiating CBT before starting a tailored HF self-care intervention does not increase the benefit of the self-care intervention.
URL: https://www.
gov; Unique identifier: NCT02997865.
在心力衰竭（HF）患者中，重度抑郁症和自我护理不足很常见。对于如何干预同时存在这两个问题知之甚少。本研究探讨了针对这些问题的序贯治疗方法的疗效。
HF 中的抑郁阶梯式治疗是一项单站点、单盲、随机对照试验，比较了认知行为疗法（CBT）与 HF 患者重度抑郁症的常规护理（UC）。CBT 干预的强化阶段持续 8 至 16 周，取决于抑郁改善的速度。所有参与者在随机分组后 8 周接受量身定制的 HF 自我护理干预。自我护理干预的强化阶段在随机分组后 16 周结束。主要结局测量指标为第 16 周的贝克抑郁量表（第 2 版）和 HF 自我护理指数的维持量表（第 6.2 版）。
共纳入 139 例 HF 合并重度抑郁症患者，其中 70 例随机分配至 UC 组，69 例随机分配至 CBT 组。在第 16 周，CBT 组患者的贝克抑郁量表（第 2 版）评分比 UC 组低 4.0 分（[95%置信区间，-7.3 至 -0.8]；=0.02）。两组患者 HF 自我护理指数维持量表的平均得分无显著差异（[95%置信区间，-6.5 至 1.5]；=0.22）。
CBT 比 HF 患者的常规护理更有效治疗重度抑郁症。然而，在开始定制 HF 自我护理干预之前启动 CBT 并不能增加自我护理干预的益处。
网址：https://www.
gov；独特标识符：NCT02997865。
