Quality of Life - Project description
Background
The quality of life of patients with chronic heart failure is severely adversely affected; many patients suffer from comorbid anxiety and depression. This constitutes a risk factor for difficulties in compliance with necessary treatment measures as well as for increased hospitalization and increased mortality. Until now, reliable information regarding the quality of life and depression throughout the course of the illness depending on age, gender and the health care infrastructure has been lacking. There is hardly any research on approaches to interventions for improving quality of life and adequate diagnosis and treatment of depressive comorbidity.
Objective
For the first time in Germany a nationwide, representative documentation of the quality of life and screening for depression that covered all patient groups was carried out. The interrelations and development of quality of life, psychosocial and somatic factors were investigated in selected groups of patients. Based on these results, interventions for patients with severely impaired quality of life and depressive illnesses were developed. To optimize the quality of life and health care for patients with heart failure in primary care practices, training and care approaches for primary care practices were designed and evaluated.
Implementation
By the end of the second support phase, 12,000 records of patient quality of life and depression were created by the Heart Failure Competence Network. A cross-sectional study of the network-wide screening data on depression was presented at the spring conference of the German Cardiac Society in Mannheim. We confirmed that the objectively measurable restriction of the cardiac pump function is not associated with the existence of depression. The review of this finding and the analysis of possible predictive factors for a depression based on process data are in preparation. In addition, we are carrying out studies on gender-specific aspects of quality of life in collaboration with SP 13 and on depression in HIV-positive patients with coronary disease in cooperation with SP 9b.
Within the local cardiological research network HELUMA (Heidelberg, Ludwigshafen, Mannheim) the HELPS study, which included over 350 patients, was completed. Among other things, it showed that standardized screening for depression and quality of life was a useful and economical complement to the diagnostic procedures for patients with heart failure (Holzapfel&Zugck et al., 2007 Psychosomatics). Moreover, we showed that depressed patients with heart failure described their symptoms of depression differently than depressed patients without coronaryheart disease, which could be a reason for the low rate of diagnosis of depression (Müller-Tasch et al., 2008 J Card Fail). Every 10th patient with a chronic heart failure also suffers from symptoms of a panic disorder (Müller-Tasch et al., 2008 J Psychosom Res). In the second support phase, a specific psychotherapeutic intervention was developed for patients with manifest depressive comorbidity and this will be evaluated in a randomized clinical trial.
In the primary care sector, the train-the-trainer (ttt) study was carried out to evaluate a training program for primary care physicians to improve the quality of life and health care for patients with chronic heart failure. Based on this, we were able to show that the compliance of the primary care physicians with the guidelines, measured by the prescription rates, was very good; however, with regard to the tapered reduction of ACE inhibitors/ AT1 blockers and beta blockers it was further optimized (Peters-Klimm et al., 2008, Clin Res Cardiol). In the second support phase, practice-based case management was developed as part of a randomized controlled study in the HICMan study and tested on 200 patients with heart failure over a period of 12 months (Peters-Klimm et al., 2008 BMC Cardiovasc Disord). The databases were closed in mid-2008, so that initial results are expected at the end of the year.
Added value via networking
Maximum horizontal networking was achieved in both support phases with the implementation of a screening for quality of life and depression in the basic record of the competence network. The aforementioned collaborations provide a solid foundation for future projects. Optimal vertical networking and thus the transfer of specialist expertise into daily practice were achieved by involving the primary care practices in the ttt and HICMan studies.