Effectiveness of a Multicomponent Positive Psychology Intervention on Depression and Optimism in a Heart Failure Clinic: A Program Design and Evaluation Initiative

Purpose: Depression, a significant problem in the Heart Failure (HF) population, is prospectively associated with increased hospital readmissions and doubled mortality risk when compared to non-depressed HF patients. Whether a Positive Psychology Intervention (PPI) can result in increased optimism and improved depression symptoms is not known. Design: Our aim was to examine the efficacy of a 6-week, phone-based, PPI in patients with heart failure. In this prospective, cohort study, we explored the feasibility of implementing this approach in a HF clinic (HFC) at a large, academic institution. All patients attending a HFC complete the patient-reported outcomes assessment including the PROMIS Depression (PROMIS-D). Patients with PROMIS-D score ≥ 55 were eligible for the pilot. Study interventions consisted of a 6-week PPI with treatment manual along with serial PHQ-9, one Likert-style optimism question, and repeat PROMIS-D. Results: Out of 305 patients screened, 47 were approached for PROMIS-D scores ≥ 55, 37 started the PPI, and 13 completed at least 3 exercises, and 6 completed the full 6-week course. Average completion time among finishers was 7.5 weeks (range 47-60 days). The PPI resulted in significant decreases in PHQ-9 scores (median difference= -1, p=0.016) and PROMIS-D scores (median difference= -7, p=0.03) and an increase in optimism score (median difference= +1, p=0.016) (refer to Figure 1). Conclusions: In HF patients completing at least three weeks of PPI, we observed promising improvement in patient-reported symptoms of depression and optimism. Approaches to improve acceptance and adherence to PPI should be explored, coupled with repeated testing of this PPI with larger samples. This project will continue to evolve in Cardiac Rehabilitation, where it is anticipated that flexible workflow dynamics and increased follow-up will improve adherence.