Cognitive Restructuring to Decrease Depressive Symptoms and Improve Self-Management of Patients with Heart Failure.
Ann Peden, Project Director
The specific aim of this pilot study is to test the effects of a cognitive restructuring intervention on psychological (negative thinking and depressive symptoms) and physiological (heart rate variability and urine norepinephrine) outcomes, self-management behaviors (adherence) and clinical outcomes (heart failure symptoms and quality of life) in patients with heart failure (HF). Despite advances in medical treatment of HF, the prognosis of patients remains extremely poor. Recently, depression has been recognized as a common problem for HF patients and a major contributor to poor self-management as well as an independent risk factor for poor clinical outcomes. The proposed study is among the first to use a cognitive-behavioral restructuring intervention to improve depressive symptoms of patients with HF with the goal of enhancing self-management abilities.
The sample will consist of the first 40 patients seen in the University of Kentucky Chandler Medical Center (UKCMC) HF Service with a diagnosis of chronic HF from an ischemic etiology who meet the following inclusion criteria and agree to participate: (1) Beck Depression Inventory score of ³ 10 or Patient Health Questionnaire score of ³ 5; (2) NYHA functional classification of II-IV; (3) optimization of medical therapy; (4) not referred for heart transplantation. Diagnosis of chronic HF with systolic dysfunction and HF etiology are confirmed in this service by a HF cardiologist using established criteria.81-82 Patients will be excluded if they have: (1) valvular heart disease as the etiology of HF; (2) history of cerebral vascular accident; (3) myocardial infarction within prior 6 months; (4) co-existing terminal illness; (5) pacemaker, atrial fibrillation or flutter; (6) taking anti-depressant medication at time of recruitment; and (7) indicate suicidal intent. Once participants are screened and deemed eligible, baseline data will be collected on depressive symptoms, negative thinking, heart rate variability, urine norepinephrine, adherence, heart failure symptoms, and quality of life.
The treatment group will receive four 90-minute group sessions over four weeks that target identification and self- management of negative thinking as it affects depressive symptoms. Control subjects will receive standard clinic care. Data will be collected at three points in time: baseline, 1-month post-intervention, and at 4-months post-intervention. The findings of this pilot study will be used in the development of a large-scale randomized controlled clinical trial to investigate the effects of cognitive restructuring in improving self-management behaviors and long-term clinical outcomes in persons with HF. This proposal addresses the public health goal of preparing individuals with chronic diseases to improve their health status by using self-management strategies.