Connect with us

Published

on

By Neha Mathur Jan 17 2024 Reviewed by Lily Ramsey, LLM

In a recent article published in JAMA Network Open, researchers compared the efficacy of antidepressant medication management (MEDS) against behavioral activation psychotherapy (BA) among inpatients admitted to a hospital with heart failure (HF) and outpatients presenting to clinics for HF follow-up, both experiencing depressive symptoms.

They conducted a randomized controlled trial (RCT) between 2018 and 2022, including a one-year follow-up within Cedars-Sinai Health System in California, United States. 

Study: Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure. Image Credit: New Africa/Shutterstock.com Background

The interplay of biological and psychosocial mechanisms gives rise to depression among ~50% of HF survivors.

As a result, HF patients with depression have poorer health-related quality of life (HRQOL) than patients with HF without depression. 

The patient's depressive symptom severity also increases the risks of decline in cognitive functions or death at six months; moreover, it is an independent factor associated with all-cause mortality.

Accordingly, the American Heart Association (AHA) recommends screening for depression in patients with HF and other heart diseases.

However, it is equally crucial to make treatments, such as antidepressant medications and psychotherapy, available for patients diagnosed with depression, which often is not the case.

Some notable evidence-based treatments for depression in patients with HF are cognitive behavioral therapy (CBT), e.g., BA, and antidepressant medications, also known as pharmacotherapy. 

However, limited access to these interventions and a lack of evidence for clinicians on which intervention to use for depression treatment in HF patients are some of the issues that require attention. About the study

In the present study, researchers addressed these challenges facing clinicians, patients, and caregivers and compared the effectiveness of psychotherapy vs pharmacotherapy for patient-centered outcomes in an RCT. Related StoriesStudy sheds light on how impaired autophagy can play a role in causing heart failureGroundbreaking drug offers new hope for life-threatening heart conditionTaking medical cannabis for chronic pain linked to increased risk of arrhythmia

The study cohort had a life expectancy of over six months post-HF, confirmed by their treating physician, and depressive disorder, based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria.

The team randomly assigned participants to BA or MEDS in a 1:1 ratio. BA therapists, licensed social workers, and MEDS care managers took a 50-minute introductory session of participants, followed by 12 weekly sessions of BA or MEDS.

These sessions were run monthly for three months, followed by contact for six more months, as deemed necessary.

They delivered 50-minute BA and 15-minute MEDS sessions on telephone/video call, which was easy to access for HF patients, saved time, and improved adherence to the program; additionally, it improved mood and HRQOL without compromising efficacy.

This trial had multiple outcomes of interest, with depressive symptom severity at six months, measured by the patient health questionnaire 9-item (PHQ-9) being the primary outcome.

Secondary outcomes were physical/mental HRQOL and HF-specific HRQOL, measured using the short-form 12-item version 2 (SF-12) and Kansas City cardiomyopathy questionnaire, respectively.

The team also monitored caregiver burden, measured using the caregiver burden questionnaire for HF; additionally, they collected emergency department (ED) visits, readmissions, days of hospitalization, and mortality at three, six, and 12 months. Results

Of 416 patients with HF enrolled in this RCT, 243 were male, and the median age of the study participants was 60.71 years. 

Both BA and MEDS groups had 208 patients whose mean (SD) PHQ-9 scores at baseline were 14.54 (3.45)and 14.31 (3.60), respectively.

Even at six months, their PHQ-9 scores were not statistically different (7.53 vs 8.09; P=0.88). Moreover, both BA and MEDS recipients experienced ~50% reduction in depressive symptoms at three, six, and 12 months.

On other measures, for instance, physical HRQOL at six months, 

BA recipients showed fewer improvements than MEDS recipients (mean SF-12 physical score: 38.82 vs 37.12; P=0.04).

They also had fewer ED visits and had to spend fewer days in the hospital at all three-time points, all statistically significant observations. 

However, there was no significant difference in hospital readmissions of BA group participants versus MEDA recipients. 

The authors attributed these differences to poor general health, a reliable risk factor associated with rehospitalization in patients with HF and depression.

It is also noteworthy that BA recipients are encouraged to be more physically active than MEDS recipients, which likely would have contributed to their tendency to have fewer ED visits and hospital days. Conclusions

Overall, the present RCT confirmed that both interventions, BA and MEDS, reduced depressive symptoms in patients with HF and depression by almost 50%.

In addition, BA recipients experienced better physical HRQOL, made fewer ED visits, and had fewer days hospitalized. 

This data could inform clinicians and caregivers that they can choose both psychotherapy and pharmacotherapy to improve depressive symptoms in HF patients. Journal reference:

Waguih W I, (2024), Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure A Randomized Clinical Trial, JAMA Network Open. doi:10.1001/jamanetworkopen.2023.52094.

Continue Reading

Politics

NATO will force the UK to increase defence spending to 3.5% of GDP to keep US on side, Sky News understands

Published

on

By

UK will be forced to increase defence spending to 3.5% to keep US on side, Sky News understands

The UK will be forced to agree this month to increase defence spending to 3.5% of national income within a decade as part of a NATO push to rearm and keep the US on side, Sky News understands.

The certainty of a major policy shift means there is bemusement in the Ministry of Defence (MoD) about why Sir Keir Starmer‘s government has tied itself in knots over whether to describe an earlier plan to hit 3% of GDP by the 2030s as an ambition or a commitment, when it is about to change.

The problem is seen as political, with the prime minister needing to balance warfare against welfare – more money for bombs and bullets or for winter fuel payments and childcare.

Follow live updates: Does the UK need an ‘Iron Dome’ system?

Prime Minister Sir Keir Starmer stands next to a New Zealand soldier during a visit to a military base during a visit to a military base training Ukrainian troops in the West of England. Picture date: Tuesday April 22, 2025. PA Photo. See PA story POLITICS Ukraine. Photo credit should read: Finnbarr Webster/PA Wire
Image:
Prime Minister Sir Keir Starmer during a visit to a military base training Ukrainian troops in April. File pic: PA

Sir Keir is due to hold a discussion to decide on the defence spending target as early as today, it is understood.

As well as a rise in pure defence spending to 3.5% by 2035, he will also likely be forced to commit a further 1.5% of GDP to defence-related areas such as spy agencies and infrastructure. Militaries need roads, railway networks, and airports to deploy at speed.

This would bolster total broader defence spending to 5% – a target Mark Rutte, the head of NATO, wants all allies to sign up to at a major summit in the Netherlands later this month.

It is being referred to as the “Hague investment plan”.

Asked what would happen at the summit, a defence source said: “3.5% without a doubt.”

Yet the prime minister reiterated the 3% ambition when he published a major defence review on Monday that placed “NATO first” at the heart of UK defence policy.

Please use Chrome browser for a more accessible video player

What’s in the UK Strategic Defence Review?

The defence source said: “How can you have a defence review that says NATO first” and then be among the last of the alliance’s 32 member states – along with countries like Spain – to back this new goal?

Unlike Madrid, London presents itself as the leading European nation in the alliance.

A British commander is always the deputy supreme allied commander in Europe – the second most senior operational military officer – under an American commander, while the UK’s nuclear weapons are committed to defending the whole of NATO.

Even Germany, which has a track record of weak defence spending despite boasting the largest economy, has recently signalled it plans to move investment towards the 5% level, while Canada, also previously feeble, is making similar noises.

Please use Chrome browser for a more accessible video player

Is the UK battle ready?

The source signalled it was inconceivable the UK would not follow suit and said officials across Whitehall understand the spending target will rise to 3.5%.

The source said it would be met by 2035, so three years later than the timeline Mr Rutte has proposed.

Defence spending is currently at 2.3%.

A second defence source said the UK has to commit to this spending target, “or else we can no longer call ourselves a leader within NATO”.

Please use Chrome browser for a more accessible video player

PM challenged on NATO, defence and Gaza

Read more:
UK to build weapons factories
Russian-linked hackers targeted MoD

Sky News’s political editor Beth Rigby challenged the prime minister on the discrepancy between his spending ambitions and those of his allies at a press conference on Monday.

Sir Keir seemed to hint change might be coming.

“Of course, there are discussions about what the contribution should be going into the NATO conference in two or three weeks’ time,” he said.

“But that conference is much more about what sort of NATO will be capable of being as effective in the future as it’s been in the last 80 years. It is a vital conversation that we do need to have, and we are right at the heart of that.”

New Sky News podcast launches on 10 June – The Wargame simulates an attack by Russia to test UK defences

Mr Rutte, a former Dutch prime minister, said last week he assumes alliance members will agree to a broad defence spending target of 5% of gross domestic product during the summit in The Hague on 24 and 25 June.

NATO can only act if all member states agree.

“Let’s say that this 5%, but I will not say what is the individual breakup, but it will be considerably north of 3% when it comes to the hard spend [on defence], and it will be also a target on defence-related spending,” the secretary general said.

The call for more funding comes at a time when allies are warning of growing threats from Russia, Iran, and North Korea as well as challenges posed by China.

But it also comes as European member states need to make NATO membership seem like a good deal for Donald Trump.

The leaders of all allies will meet in The Hague for the two-day summit.

👉 Listen to Sky News Daily on your podcast app 👈

The US president has repeatedly criticised other member states for failing to meet a current target of spending 2% of national income on defence and has warned the United States would not come to the aid of any nation that is falling short.

Since returning to the White House, he has called for European countries to allocate 5% of their GDP to defence. This is more than the 3.4% of GDP currently spent by the US.

Mr Rutte is being credited with squaring away a new deal with Mr Trump in a meeting that would see allies increase their defence spending in line with the US president’s wishes.

The NATO chief is due to visit London on Monday, it is understood.

Continue Reading

Environment

Nissan reveals new photos of the next-gen LEAF EV and confirms its global debut

Published

on

By

Nissan reveals new photos of the next-gen LEAF EV and confirms its global debut

The iconic electric hatch is all grown up and will arrive later this month. Nissan’s iconic EV is now a stylish crossover with more range, faster charging, and several other upgrades. Ahead of its global debut, Nissan is offering us a closer look at the third-gen LEAF EV with a few new photos and details.

Nissan LEAF EV photos and global debut date

Nissan is upgrading its best-selling EV in nearly every way possible. We got a sneak peek of the new model in March, but it was essentially a preview.

On Tuesday, Nissan shared several new photos and a few insights we can expect to see from the updated LEAF EV when it arrives later this month.

The LEAF is dropping the hatchback style we’ve grown to love (or hate) for a “sleek and spacious family-friendly crossover” design. Nissan’s design and engineering teams worked together to give it a bold new look, but it’s also surprisingly efficient.

Advertisement – scroll for more content

With a drag coefficient of just 0.26, the new model (US and Japan-spec) is about as aerodynamic as an average sports car. In Europe, it’s even more impressive at just 0.25 Cd, down from 0.28 Cd in the outgoing LEAF.

Nissan-LEAF-EV-photos
Richard Candler, Vice President, Nissan global product strategy, next to the third-generation LEAF EV (Source: Nissan)

All new models (US, Japan, and Europe) feature added flush door handles, an active grille shutter, improved wheel design, a new fastback silhouette, and a flat underbody for better efficiency.

“Every design choice was optimized for aero and energy efficiency, even the panoramic glass roof contributes to exceptional aerodynamics,” according to Nissan’s program design director, Nobutaka Tase.

The third-gen LEAF is based on Nissan’s CMF-EV platform, the same one that underpins the Ariya electric SUV. Although Nissan has yet to confirm the battery specs, it promises that the new model will have “significant range improvements” compared to the outgoing LEAF.

We may have an idea after Nissan’s vehicle programs chief, François Bailly, told TopGear.com that the new LEAF will arrive with a 373-mile (600 km) WLTP driving range.

Nissan-new-LEAF-EV-photos
Nissan’s new LEAF EV (Source: Nissan)

On the EPA scale, it could be closer to a 300-mile range, but that would still be a significant improvement from the 212 EPA-estimated miles offered on the 2025 LEAF SV Plus.

In North America, the new Nissan LEAF will also feature a built-in NACS port, unlocking access to Tesla’s Supercharger network.

You can learn more about the updated model in the video above. The short series features the planning, design, and engineers who helped bring the third-gen EV to life.

We will find out more later this month when Nissan officially launches the updated LEAF. Check back soon for more info. We’ll keep you updated with the latest.

Do you like the updated LEAF design? The crossover style gives it a fresh new look. Let us know your thoughts in the comments below.

FTC: We use income earning auto affiliate links. More.

Continue Reading

Environment

NIO shares plans to enter seven additional European markets

Published

on

By

NIO shares plans to enter seven additional European markets

Chinese EV automaker NIO took to social media to announce expansion plans to seven new European markets. This multi-brand strategy will bring even more BEVs from NIO and Firefly to EU customers.

NIO ($NIO) is looking to add clout to its status as a rising global brand. It was only four years ago that the Chinese EV automaker announced its first expansion plans into European markets, beginning in Norway. The company has since set up sales in Denmark, Germany, the Netherlands and Sweden.

Those EU models include the NIO ES6, ES7, ES8, ET5, ET5T, and ET7. However, due to a trademark dispute with Audi, the “ES” models have been renamed “EL” in the EU (EL6, EL7, etc).

Additionally, NIO has recently begun selling the two flagship EVs from its sub-brands, the Onvo L60 and Firefly, to European customers.

Advertisement – scroll for more content

Earlier today, NIO took to X and Weibo to announce additional expansion plans for Europe, including sales of the Firefly.

NIO European
The Firefly on display at the Shanghai Auto Show / Source: Scooter Doll

NIO and Firefly to expand to these seven European markets

Per the post on X, NIO intends to begin selling its BEVs in the following European markets through 2025 and 2026:

  • Austria
  • Belgium
  • The Czech Republic
  • Hungary
  • Luxembourg
  • Poland
  • Romania

NIO divulged even more details on Weibo, including what models will be sold in those additional EU markets. Those BEVs include the EL6, EL8, ET5, ET5 Touring (ET5T), and the Firefly EV (seen above). Per the post:

In the Belgian and Luxembourg markets, NIO will cooperate with Hedin Mobility Group, a leading European travel service group. In Central and Eastern Europe, NIO will join hands with AutoWallis, a leading regional travel service group, to first cover the Austrian and Hungarian markets in 2025, and plans to start deliveries in the Czech Republic, Poland and Romania in 2026, bringing innovative, sustainable and high-quality smart electric travel experiences to local users.

There you have it. Five BEV models across two NIO brands, reaching new European customers as early as this year. We’re sure this won’t be the last we hear about Firefly in Europe, as the NIO sub-brand was supposed to initially launch overseas ahead of China. NIO co-founder and president, Qin Lihong, recently told CnEVPost that Firefly would enter approximately 20 overseas markets by the end of 2025, with the right-hand drive version expected to hit the market in October at the latest.

FTC: We use income earning auto affiliate links. More.

Continue Reading

Trending