Personalized Treatments for Depressive Symptoms in Patients With Advanced Heart Failure

Aim 1: To compare the effectiveness of BA vs. MEDS, for depressed AHF patients. Hypothesis 1:
Compared to depressed AHF patients who receive MEDS, patients receiving BA will have
significantly greater improvements in the primary outcome of depressive symptom severity as
measured with the PHQ-9 at 6-month follow-up. Significantly greater improvements will also be
detected in the secondary outcomes of general physical and mental HRQoL (SF-12), heart
failure-specific HRQoL (KCCQ), and caregiver burden (CBQ-HF) at 3, 6, and 12 months.

Aim 2: To compare the impact of BA vs. MEDS on disadvantageous outcomes of Morbidity (as
evidenced by ED visits, hospital readmissions, total days in the hospital), and Mortality
among depressed AHF patients.

Hypothesis 2: Compared to depressed AHF patients who receive MEDS, those receiving BA will
have significantly less Morbidity (as evidenced by less frequent ED visits, lower readmission
rates, fewer total days in the hospital), and reduced Mortality at the data collection points
of 3, 6, and 12 months.

Inclusion Criteria:

1. HF New York Heart Association classes: II-IV.

2. Life expectancy of more than 6 months.

3. PHQ-9 score ≥10.

4. Diagnosis of Major Depressive Disorder, Persistent Depressive Disorder (Dysthymia),
and Depressive Disorder Unspecified, as confirmed by the MINI 7.02.

Exclusion Criteria:

1. Imminent danger to self or others.

2. Cognitive impairments with a MOCA score of < 23.

3. Bipolar, Psychotic, and Substance-induced Disorders.

4. Patients in active treatment of depression who are already on antidepressants,
psychotherapy, or both.