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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.

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Politics

The ‘£7bn’ government secret

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The '£7bn' government secret

👉 Click here to listen to Electoral Dysfunction on your podcast app 👈

Who knew what about the Afghan data leak? And could anyone in parliament have done more to help scrutinise the government at the time of the superinjunction? Harriet thinks so.

So in this episode, Beth, Ruth, and Harriet talk about the massive breach, the secret court hearings, and the constitutional chaos it’s unleashed.

Plus – the fallout from the latest Labour rebellion. Four MPs have lost the whip – officially for repeated defiance, but unofficially? A government source called it “persistent knobheadery”.

So is Keir Starmer tightening his grip or losing control? And how does this compare to rebellions of Labour past?

Oh and singer Chesney Hawkes gets an unexpected mention.

Responding to claims in the podcast about whether Commons Speaker Sir Lindsay Hoyle could have scrutinised the government, a Commons spokesperson said: “As has been made clear, Mr Speaker was himself under a superinjunction, and so would have been under severe legal restrictions regarding speaking about this. He would have had no awareness which organisations or individuals were and were not already aware of this matter.

More on Afghanistan

“The injunction could not constrain proceedings in parliament and between being served with the injunction in September 2023 and the 2024 General Election Mr Speaker granted four UQs on matters relating to Afghan refugees and resettlement schemes.

“Furthermore, as set out in the Justice and Security Act 2013, the Speaker has no powers to refer matters to the Intelligence and Security Committee.”

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World

England through to semi-finals of Women’s Euros after beating Sweden on penalties

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England through to semi-finals of Women's Euros after beating Sweden on penalties

England have booked their place in the semi-finals of the Women’s Euros after knocking out Sweden.

The Lionesses won 3-2 on penalties at Stadion Letzigrund in Zurich, Switzerland, after clawing their way back to take the game into extra-time.

The defending champions had been 2-0 down at half-time after goals from Sweden’s Kosovare Asllani and Stina Blackstenius in the quarter-final clash.

England then levelled matters towards the end of normal time. Lucy Bronze delivered the first England goal on 79 minutes, assisted by substitute Chloe Kelly. Two minutes later, Michelle Agyemang followed suit, taking the score to 2-2.

England goalkeeper Hannah Hampton (R) celebrates with teammates after the side beat Sweden. Pic: AP
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England goalkeeper Hannah Hampton (R) celebrates with teammates after the side beat Sweden. Pic: AP

Soccer Football - UEFA Women's Euro 2025 - Quarter Final - Sweden v England - Stadion Letzigrund, Zurich, Switzerland - July 17, 2025 Englan
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Bronze’s penalty kept England’s hopes alive. Pic: Reuters

After a goalless extra-time, it was time for penalties.

Alessia Russo kicked things off, finding the back of the net for England, before Lauren James, Alex Greenwood, Beth Mead and Grace Clinton had their attempts saved by Sweden’s Jennifer Falk.

The game was sent into sudden death after Falk went face-to-face with England’s Hannah Hampton but sent the ball flying over the crossbar.

Soccer Football - UEFA Women's Euro 2025 - Quarter Final - Sweden v England - Stadion Letzigrund, Zurich, Switzerland - July 17, 2025 Englan
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Pic: Reuters

Soccer Football - UEFA Women's Euro 2025 - Quarter Final - Sweden v England - Stadion Letzigrund, Zurich, Switzerland - July 17, 2025 Sweden
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A devastated Sweden. Pic: Reuters

It all came down to Sweden’s seventh penalty after Bronze sensationally scored, with 18-year-old Smilla Holmberg missing the chance to send her team through.

England will next face Italy in the semi-finals in Geneva on Tuesday.

‘That was crazy’

England boss Sarina Wiegman described the action as “one of the hardest games I’ve ever watched”.

Soccer Football - UEFA Women's Euro 2025 - Quarter Final - Sweden v England - Stadion Letzigrund, Zurich, Switzerland - July 17, 2025 Englan
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Sarina Wiegman after the match. Pic: Reuters

“We could have been out of the game three or four times, when you’re 2-0 at half-time it’s not good,” she said after the match.

“Although we started really bad, at the end it got better, but we didn’t create anything so we had to change shape, and we score two goals – that was crazy.

“We miss a lot [of penalties], and they miss even more. I need to decompress, I think.”

Soccer Football - UEFA Women's Euro 2025 - Quarter Final - Sweden v England - Stadion Letzigrund, Zurich, Switzerland - July 17, 2025 Englan
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Hannah Hampton still delivered with one nostril down. Pic: Reuters

Goalkeeper Hampton added that it was “stressful watching” and “stressful playing”.

The 24-year-old, who was left with a bloodied nose in extra-time, said: “Every time I saved one, I was just thinking ‘please put it in, so we have a bit of a cushion!’

“To be honest, I think I was better in the game when I had one nostril than when I was completely fine!”

She said it was the support of the England fans that helped the team push on. She said: “They were definitely behind me and I appreciate all the support.”

Soccer Football - UEFA Women's Euro 2025 - Quarter Final - Sweden v England - Stadion Letzigrund, Zurich, Switzerland - July 17, 2025 Englan
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Michelle Agyemang reacts after levelling the game for the Lionesses. Pic: Reuters

Soccer Football - UEFA Women's Euro 2025 - Quarter Final - Sweden v England - Stadion Letzigrund, Zurich, Switzerland - July 17, 2025 Sweden
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Pic: Reuters

Pressure was on the Lionesses after they won the tournament in 2022.

Their journey in the group stages started with a 2-1 defeat to France, but hopes were lifted after England sailed past the Netherlands and Wales to reach the knockout stages, finishing second in Group D.

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Sweden on the other hand went into Thursday’s game unbeaten in the tournament so far, having already defeated Germany, Poland and Denmark in the group stages.

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World

Lionesses went from sloppy to celebratory in nerve-shredding euros quarter-final

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Lionesses went from sloppy to celebratory in nerve-shredding euros quarter-final

By the time Hannah Hampton appeared in the news conference, the England goalkeeper was relieved, ecstatic and wanting to share this night far and wide.

So when her phone started ringing with a FaceTime call, she broke off speaking to the media about reaching the Euros semi-finals to answer it.

And then share the call with the room in Zurich.

After such a nerve-shredding night, this was the moment to relax and just savour it all.

Savour how close they came to throwing it all away against Sweden before staging a stirring comeback inspired by Lucy Bronze.

The 33-year-old scored the goal that began the fightback with 11 minutes to go and converted England’s final penalty in the shootout.

Soccer Football - UEFA Women's Euro 2025 - Quarter Final - Sweden v England - Stadion Letzigrund, Zurich, Switzerland - July 17, 2025 Englan
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Lucy Bronze converted England’s final penalty. Pic: Reuters

“Lucy Bronze is one of a kind,” England manager Sarina Wiegman said. “It’s that resilience, that fight. I think the only way to get her off the pitch is in a wheelchair.”

The Lionesses looked down and out, 2-0 down after 25 minutes.

Completely outplayed. A defence run ragged. Just too sloppy.

“We said at half-time we don’t want to go home,” Hampton said. “So it’s up to us to turn the game around.”

Soccer Football - UEFA Women's Euro 2025 - Quarter Final - Sweden v England - Stadion Letzigrund, Zurich, Switzerland - July 17, 2025 Englan
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Things were not looking good for England by half-time. Pic: Reuters

Soccer Football - UEFA Women's Euro 2025 - Quarter Final - Sweden v England - Stadion Letzigrund, Zurich, Switzerland - July 17, 2025 Englan
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But the team managed to turn things around. Pic: Reuters

That only came after Wiegman deployed the substitutes the manager calls “finishers”.

They fulfilled their mission.

“Sweden in that moment had to adapt to some different things in the game,” Wiegman said, “before they could, it was 2-2.”

Within seconds of coming on, match-winner Chloe Kelly showed the missing spirit. The spirit that saw her score the Euro 2022 winner.

Soccer Football - UEFA Women's Euro 2025 - Quarter Final - Sweden v England - Stadion Letzigrund, Zurich, Switzerland - July 17, 2025 Sweden
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Pic: Reuters

A creator of two goals in 103 seconds.

A cross headed in with 11 minutes to go by Bronze – the only player still playing from the Euro 2013 group-stage elimination.

It was a lifeline seized on so quickly.

Another cross from Kelly was this time brought down by Beth Mead before Michelle Agyemang.

The timeliest of goals from the teen – a first tournament goal on her third appearance as a sub.

Soccer Football - UEFA Women's Euro 2025 - Quarter Final - Sweden v England - Stadion Letzigrund, Zurich, Switzerland - July 17, 2025 Englan
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Teenager Michelle Agyemang reacts after scoring England’s second goal in normal time. Pic: Reuters

But there would be the anxiousness of extra time to follow, unable to find a breakthrough.

So to the shootout that lasted 14 penalties between them.

Hampton said: “It was stressful watching and playing, I thought every single time when I saved one, ‘Please score and give us a cushion’. I feel so happy and relieved.”

Around Alessia Russo and Kelly scoring there were four England misses before Bronze converted England’s seventh and Sweden missed a fifth.

Read more:
How far has women’s football come since 1972?
Lioness star explains what ‘Proper England’ is

A frenzied 3-2 shootout win was complete.

“I can’t remember anything like this,” said Wiegman, who has only reached finals in her four tournaments with the Netherlands and England.

“I thought three times we were out,” she said.

But instead it’s off to Geneva for the European champions for a semi-final with Italy.

They’ll be hoping it’s less of a struggle, less dramatic – while just glad to have made it there.

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