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Depression and Heart Failure

Hi. This is Ileana Piña from Albert Einstein College of Medicine in Montefiore Medical Center in the Bronx, New York. Today I am here in the beautiful city of Amsterdam at the European Society of Cardiology (ESC) Annual Sessions. The place is bustling with activity. It is highly organized with highly informative sessions and hot topics from late-breaking trials. You will hear more about these in sessions later on. Today I want to talk to you briefly about the presentation that I am going to give tomorrow, which has to do with depression and heart failure.

Depression is highly prevalent in patients with heart failure. We have data from our HF-ACTION trial using the Beck Depression Inventory II (BDI-II) that 40%-43% of the patients have BDI-II scores > 10 (> 10 is considered depression, and > 14 is considered severe depression). The BDI-II is extremely easy to administer to patients. When we look at the HF-ACTION data at baseline, we see no difference in any of the objective measures of sickness, such as ejection fraction; however, the more subjective measures of sickness and the impact on health status are vastly different. The patients who are depressed have much lower (worse) scores on the Kansas City Cardiomyopathy Questionnaire, and their perception of their symptoms, according to the New York Heart Association Functional Classification, is worse.

Let's take it one step further. Can medications change this? Should medications be given to the patients or are there other strategies for dealing with depression? The SADHART trial looked at a drug called sertraline, a selective serotonin reuptake inhibitor that has been used extensively for the treatment of depression. SADHART was a randomized controlled trial published by Dr. Chris O'Connor,[1] in which a large number of patients were randomly assigned to a nurse management program involving nurse counseling plus drug or placebo, and there was absolutely no change and no difference in outcomes.


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