Depression and Heart Failure Disease Progression

Sponsor

Duke University (Other)

Overall Status

Completed

CT.gov ID

NCT02131428

Collaborator

(none)

186

Enrollment

Location

Duration (Months)

2.2

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Heart failure is the most costly diagnosis in the Medicare population. Clinical depression is strikingly common in heart failure patients, and not only diminishes their quality of life, but also is associated with a markedly increased risk of hospitalization or death. This study is designed to further our understanding of the behavioral and biological effects of depression in patients with heart failure, so that appropriate treatments can be developed.

Condition or Disease	Intervention/Treatment	Phase
Heart Failure

Detailed Description

There are over five million Americans living with heart failure (HF), and another 670,000 new cases being diagnosed each year. HF is a characteristically unstable condition that is the most costly diagnosis in the Medicare population and is the most common cause for hospitalization. The instability of HF disease is reflected in short-term fluctuations of the HF disease biomarker, B-Type Natriuretic Peptide (BNP). Patient self-management behaviors are important for minimizing HF disease instability. Depression is often comorbid with HF, and elevated depressive symptoms are associated with a marked increase in adverse clinical outcomes. For both depressed and non-depressed HF patients, worsening depressive symptoms mark a substantially increased risk of cardiovascular hospitalization or death. Despite the risk associated with depressive symptoms, the nature of their association with a worsening HF disease trajectory and adverse clinical outcomes is poorly understood.

Converging evidence suggests that the association between depressive symptoms and accelerated HF disease progression may involve multiple behavioral and pathophysiological pathways. This study proposes an innovative, prospective bio-behavioral monitoring study of 220 HF patients that is designed to address the issue of how depressive symptoms and their bio-behavioral manifestations are implicated in worsening HF disease. Using home-monitoring biotechnology, we propose to track fluctuations in HF disease severity using biweekly assessments of BNP over a 16-week period. Symptoms of depression and HF-related health behaviors also will be assessed biweekly via concurrent monitoring. This biweekly bio-behavioral monitoring will be framed by comprehensive baseline and 4-month assessments of depression, HF disease severity, and pathophysiological mechanisms that have been related to the presence of depressive symptoms and implicated in the progression of HF disease. Clinical outcomes also will be assessed over a 5 year follow-up period. This study will create a unique data structure that will allow us to use contemporary statistical methods that will serve to elucidate causal associations between depressive symptoms, self-management health behaviors, pathophysiological processes, and HF disease progression and clinical outcomes. The study findings are expected to yield important advances in our understanding of why depressive symptoms may be particularly detrimental in the presence of HF and will help to inform the design of future clinical trials.

Study Design

Study Type:

Observational

Actual Enrollment :

186 participants

Observational Model:

Cohort

Time Perspective:

Prospective

Official Title:

Depression and Heart Failure Disease Progression

Study Start Date :

Nov 1, 2014

Actual Primary Completion Date :

Dec 1, 2021

Actual Study Completion Date :

Dec 1, 2021

Outcome Measures

Primary Outcome Measures

Time to Hospitalization or Death [5 years]
Time to hospitalization or death
Change in Quality of Life [Bi-weekly of a 4-month period, 4 months, 1 year]
Psychosocial measures of Quality of Life
Change in Self-Management Behaviors [Bi-weekly of a 4-month period, 4 months, 1 year]
Health Behaviors
Change in Heart Failure Disease Biomarkers [Bi-weekly of a 4-month period, 4 months, 1 year]
Disease Biomarkers

Eligibility Criteria

Criteria

Ages Eligible for Study:

21 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Men or women aged 21 years or older
Heart Failure of at least 3-months duration
Left ventricular Ejection Fraction (EF) ≤ 45% by left ventricular angiography, nuclear wall motion study, or echocardiography, Or
Preserved ejection fraction with either: Hospitalization within the previous 12 months with management of heart failure as a major component of the care provided; or Elevated natriuretic peptide level (NT-proBNP ≥ 360 pg/ml or BNP ≥ 100 pg/ml) within 6 months of enrollment.
Undergoing treatment with a stable medication regimen.

Exclusion Criteria:

Myocardial Infarction (MI), within 1 month of enrollment
Percutaneous Transluminal Coronary Angioplasty(PTCA), Coronary Artery Bypass Graft (CABG) within 3 month of enrollment
HF due to correctable cause or condition such as uncorrected primary valvular disease
Alcohol or drug abuse within 12 months
Illness such as malignancies that are associated with a life-expectancy of < 12 months
Current pregnancy
Inability to provide informed consent