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Heart Failure / Depression / Depressive Disorder · Journal article
Journal of Affective Disorders · July 30, 2026
Well-designed and adequately powered for the question it asks.
This secondary per-protocol analysis of a 416-patient pragmatic RCT found that behavioral activation and antidepressant medication were equally effective for reducing depressive symptoms in patients with comorbid heart failure and depression. However, among highly adherent patients (>75–100% completion), behavioral activation produced greater improvements in mental health–related and heart failure–specific quality of life than medication, without significant differences in depressive symptom severity or physical quality of life.
Secondary per-protocol analysis of a pragmatic, randomized comparative-effectiveness trial. 416 participants diagnosed with heart failure and DSM-5 depressive disorder; enrolled in a pragmatic comparative-effectiveness trial, 2018–2022.. Intervention: Behavioral activation (BA). Compared with: Antidepressant medication (MEDS). n = 416. Not stated in source text..
Among high-adherence patients at 6 months, BA superior to MEDS on SF-12v2-MC (Mental HRQoL difference: 5.22; 95% CI: 0.72–9.72; p=0.023) Among high-adherence patients at 6 months, BA superior to MEDS on KCCQ-OS (HF-specific HRQoL difference: 16.08; 95% CI: 7.20–24.97; p<0.001) Among high-adherence patients at 6 months, BA superior to MEDS on KCCQ-CS (HF-specific HRQoL difference: 16.04; 95% CI: 7.05–25.02; p<0.001)
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Among patients with comorbid heart failure and depression who adhere well to treatment (>75–100%), behavioral activation may offer superior improvements in quality of life compared to antidepressant medication, though both are equally effective for reducing depressive symptom severity. Clinicians should consider treatment preferences and adherence capacity when choosing between these approaches.
A rigorous per-protocol analysis of a pragmatic RCT with 416 participants and 1-year follow-up showing a clear, pre-specified outcome (quality of life endpoints) with reported effect sizes and confidence intervals, though limited by secondary analysis design and lack of primary endpoint difference.
As stated by the source record.
Quoted from the source exactly as published.
Among patients with comorbid heart failure and depression who adhere well to treatment (>75–100%), behavioral activation may offer superior improvements in quality of life compared to antidepressant medication, though both are equally effective for reducing depressive symptom severity. Clinicians should consider treatment preferences and adherence capacity when choosing between these approaches.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background. Depression affects nearly half of patients with heart failure (HF), which is associated with increased morbidity and reduced health-related quality of life (HRQoL). This secondary per-protocol analysis of a previously published randomized trial evaluated the behavioral activation (BA) versus antidepressant medication (MEDS) among patients with depression and HF who adhered to study interventions.Methods. This analysis is based on a pragmatic randomized comparative-effectiveness trial conducted from 2018 to 2022, with a 1-year follow-up. 416 participants diagnosed with HF and a DSM-5 depressive disorder were randomized to BA or MEDS, and the current analysis examined outcomes according to treatment adherence.Outcomes. The primary outcome was depressive symptom severity (PHQ-9) at 6 months, and the secondary outcomes were physical and mental HRQoL (SF-12v2-PC and SF-12v2-MC, respectively) and HF-specific HRQoL (Kansas City Cardiomyopathy Questionnaire; KCCQ) overall and clinical scores (KCCQ-OS and KCCQ-CS), at 3, 6, and 12 months. High adherence was defined as completion of >75-100% of intervention components. Overall adherence rates were similar between BA and MEDS. At 6 months, among patients with >75-100% adherence who followed treatment as directed in both arms, BA was associated with higher Mental HRQoL (SF-12v2-MC: 5.22; 95% CI: 0.72 to 9.72; p = 0.023) and higher HF-specific HRQoL (KCCQ-OS: 16.08; 95% CI: 7.20 to 24.97; p < 0.001); (KCCQ-CS: 16.04; 95%CI: 7.05 to 25.02; p < 0.001) compared to MEDS. There were no significant differences in depressive symptoms or physical HRQoL at 6 months.Interpretation. Both BA and MEDS were equally effective treatments for depression in HF. However, among highly adherent patients, BA was associated with greater improvements in mental and HF-specific HRQoL than MEDS.Funding/support. The study was funded by PCORI Award Number: 2017C2-7716.
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