The Support, Education, and Research in CHF Study (SEARCH)
The Support, Education, and Research in CHF Study (SEARCH)
Background: The Support, Education, and Research in Chronic Heart Failure (SEARCH) study was designed to assess the impact of a mindfulness-based psychoeducational intervention on clinical outcomes, depression, and quality of life in patients with chronic heart failure (CHF). Although research has shown that psychosocial factors including depression are important risk factors for adverse events in patients with CHF, no large clinical trials have investigated the efficacy of psychosocial interventions to reduce these factors in this population.
Methods: This was a prospective cohort study of 208 adults with left ventricular ejection fraction =40% and CHF geographically assigned to treatment or control groups with follow-up at 3, 6, and 12 months. Treatment groups met weekly for 8 consecutive weeks for training in mindfulness meditation, coping skills, and support group discussion.
Results: Subjects had a mean age of 61 years, left ventricular ejection fraction 26%, and median New York Heart Association class II. The majority were treated with angiotensin-converting enzyme inhibitors (80%) and ß-blockers (86%). At baseline, patients in the treatment group had more severe CHF with higher New York Heart Association class (P = .0209) and more severe psychological distress (Center of Epidemiology—Depression, Profile of Mood States; P < .05). When compared with controls, treatment resulted in lower anxiety (Profile of Mood States, P = .003), depression (Center of Epidemiology—Depression, P = .05), improved symptoms (Kansas City Cardiomyopathy Questionnaire symptom scale, P = .033) and clinical scores (Kansas City Cardiomyopathy Questionnaire clinical score, P = .024) over time. There were no treatment effects on death/rehospitalization at 1 year.
Conclusions: An 8-week mindfulness-based psychoeducational intervention reduced anxiety and depression; this effect was attenuated at 1 year. Importantly, the intervention led to significantly better symptoms of CHF at 12 months compared to control subjects. Our results suggest that interventions of this type might have a role in optimal therapy for CHF.
Chronic heart failure (CHF) is a disabling illness with significant morbidity and mortality that affects >5 million Americans. The morbidity of CHF includes not only physical symptoms but also significant psychological distress, including anxiety and depression, due to changes in functional level, work status, and relationships. Studies have demonstrated that significant depression in CHF is common, with prevalence rates ranging from 24% to 39%, and is related to a higher risk of functional decline. At least 2 dozen studies have shown depression to be an important risk factor for morbidity and mortality, independent of physiologic measures of disease severity. Significant depression is related to a 2.5-fold increase in mortality at 3 months and a 3-fold increase in re-hospitalization at 1 year, among hospitalized patients with CHF. Other studies have suggested that social support also has an important impact on medical outcomes in chronic heart failure. Quality of life is substantially impaired in this socially isolated population, often with higher rates of hospitalization and mortality. Although the underlying pathophysiology responsible for this major effect of depression on mortality in CHF is not fully understood, it has been demonstrated that depression causes increases in neurohormonal activation, proinflammatory cytokines, hypercoaguability, and arrhythmias that may all contribute to its deleterious effects. Despite the important impact of depression on outcomes, no large study has examined interventions aimed at psychosocial variables in CHF.
The present study examined the effects of an 8-week psychoeducational intervention on depression, anxiety, quality of life, symptoms, and medical outcomes in patients with CHF. The intervention included teaching skills based on Mindfulness Based Stress Reduction (MBSR) plus education on improving coping skills that included better social support, living with heart failure, non-denominational spirituality, and an expressive support group. Previous studies suggest that these program components can positively affect psychosocial outcomes in various patient populations. The MBSR component has been demonstrated to be helpful in coping with stress, pain, anxiety, and depression in chronic illnesses. Based on these results, we hypothesized that this treatment might result in lower levels of depression and psychological distress as measured by the Center of Epidemiology—Depression (CES-D), Kansas City Cardiomyopathy Questionnaire (KCCQ), and Profile of Mood States (POMS) in patients with CHF.
Abstract and Background
Abstract
Background: The Support, Education, and Research in Chronic Heart Failure (SEARCH) study was designed to assess the impact of a mindfulness-based psychoeducational intervention on clinical outcomes, depression, and quality of life in patients with chronic heart failure (CHF). Although research has shown that psychosocial factors including depression are important risk factors for adverse events in patients with CHF, no large clinical trials have investigated the efficacy of psychosocial interventions to reduce these factors in this population.
Methods: This was a prospective cohort study of 208 adults with left ventricular ejection fraction =40% and CHF geographically assigned to treatment or control groups with follow-up at 3, 6, and 12 months. Treatment groups met weekly for 8 consecutive weeks for training in mindfulness meditation, coping skills, and support group discussion.
Results: Subjects had a mean age of 61 years, left ventricular ejection fraction 26%, and median New York Heart Association class II. The majority were treated with angiotensin-converting enzyme inhibitors (80%) and ß-blockers (86%). At baseline, patients in the treatment group had more severe CHF with higher New York Heart Association class (P = .0209) and more severe psychological distress (Center of Epidemiology—Depression, Profile of Mood States; P < .05). When compared with controls, treatment resulted in lower anxiety (Profile of Mood States, P = .003), depression (Center of Epidemiology—Depression, P = .05), improved symptoms (Kansas City Cardiomyopathy Questionnaire symptom scale, P = .033) and clinical scores (Kansas City Cardiomyopathy Questionnaire clinical score, P = .024) over time. There were no treatment effects on death/rehospitalization at 1 year.
Conclusions: An 8-week mindfulness-based psychoeducational intervention reduced anxiety and depression; this effect was attenuated at 1 year. Importantly, the intervention led to significantly better symptoms of CHF at 12 months compared to control subjects. Our results suggest that interventions of this type might have a role in optimal therapy for CHF.
Background
Chronic heart failure (CHF) is a disabling illness with significant morbidity and mortality that affects >5 million Americans. The morbidity of CHF includes not only physical symptoms but also significant psychological distress, including anxiety and depression, due to changes in functional level, work status, and relationships. Studies have demonstrated that significant depression in CHF is common, with prevalence rates ranging from 24% to 39%, and is related to a higher risk of functional decline. At least 2 dozen studies have shown depression to be an important risk factor for morbidity and mortality, independent of physiologic measures of disease severity. Significant depression is related to a 2.5-fold increase in mortality at 3 months and a 3-fold increase in re-hospitalization at 1 year, among hospitalized patients with CHF. Other studies have suggested that social support also has an important impact on medical outcomes in chronic heart failure. Quality of life is substantially impaired in this socially isolated population, often with higher rates of hospitalization and mortality. Although the underlying pathophysiology responsible for this major effect of depression on mortality in CHF is not fully understood, it has been demonstrated that depression causes increases in neurohormonal activation, proinflammatory cytokines, hypercoaguability, and arrhythmias that may all contribute to its deleterious effects. Despite the important impact of depression on outcomes, no large study has examined interventions aimed at psychosocial variables in CHF.
The present study examined the effects of an 8-week psychoeducational intervention on depression, anxiety, quality of life, symptoms, and medical outcomes in patients with CHF. The intervention included teaching skills based on Mindfulness Based Stress Reduction (MBSR) plus education on improving coping skills that included better social support, living with heart failure, non-denominational spirituality, and an expressive support group. Previous studies suggest that these program components can positively affect psychosocial outcomes in various patient populations. The MBSR component has been demonstrated to be helpful in coping with stress, pain, anxiety, and depression in chronic illnesses. Based on these results, we hypothesized that this treatment might result in lower levels of depression and psychological distress as measured by the Center of Epidemiology—Depression (CES-D), Kansas City Cardiomyopathy Questionnaire (KCCQ), and Profile of Mood States (POMS) in patients with CHF.
