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.
On the banks of the Ohio River in a rural corner of one of America’s poorest states sit two factories, one next to the other.
One is open. The other is shuttered. Both cut to the heart of what Donald Trump hopes he can do to transform America’s industrial base.
Ravenswood, West Virginia, is a town built on aluminium. Since the 1950s, the wonder-metal has kept this place on the map.
Once upon a time, the metal itself was produced here. A massive smelting plant dominated the skyline, and inside, huge furnaces, transforming American aluminium ore (alumina) into the metal we recognise.
The newly smelted metal was then sent by river, rail and road to other factories dotted across the country to be cast – turned to sheet and coil for the nation’s cars, planes, trucks and so much more.
Image: The Kaiser Aluminium plant closed its smelters in 2009
Kaiser Aluminium closed its smelters in 2009. The plant now sits idle. Fencing surrounds it; grass partially obscures the entrance, where hundreds of workers would once have passed.
Two hundred metres down the road, there is a different story.
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Constellium Ravenswood is one of the world’s largest factories of its kind.
With over a thousand employees it produces plate, sheet and coiled aluminium for numerous industries: aerospace, defence, transportation, marine and more.
Its products are custom designed for clients including Boeing, Lockheed Martin and NASA.
But here’s the problem. The Constellium plant uses aluminium now sourced from abroad. America’s primary aluminium production has dropped off a cliff over the past few decades.
The Kaiser plant next door which could have provided the metal for its neighbour to process and press was instead the victim of cheap foreign competition and high energy costs.
Smelting aluminium requires huge amounts of constant energy. If the smelters are ever turned off, the metal inside will solidify, destroying the facility.
Image: Constellium Ravenswood is one of the world’s largest factories of its kind
In 2023, the annual rate of US primary aluminium production fell 21.4% on the previous year, according to the Aluminium Association.
However, the Canadian Aluminium Association projected that their annual production would be up by 6.12% in 2024 compared to the previous year.
The story is clear – this industry, like so many in America, is in steep decline. Competition and high production and energy costs are having a huge impact.
The danger ahead is that secondary aluminium production in America could go the way of primary production: firms down the supply chain could choose to buy their sheeting and coils from abroad too.
The answer, says President Trump, is tariffs. And the chief executive of Constellium agrees with him.
“We believe in free AND fair trade,” Jean-Marc Germain told Sky News from the company’s corporate headquarters in Baltimore. “And the point is that trade has been free but not fair.”
“There has been massive growth in the capacity installed in China. Kudos to the Chinese people, that is admirable, but a lot of that has been allowed by illegal subsidies. What it means is that overall, trade of aluminium products is broken as an international system. And I think those tariffs are a way to address some of that very uneven playing field that we are seeing today.”
Mr Germain says the tariff plan will reset the market. He accepts that blanket tariffs are a blunt and risky tool, but cuts out circumvention by one country to another.
“Obviously, this process creates some collateral damage. It is clear that not all countries and not all products are unfairly traded. But because of the sheer size of China and the history of Chinese production making its way through certain countries into the US… a blunt approach is required,” he says.
Image: Jean-Marc Germain, chief executive of Constellium, agrees with Trump’s tariffs
The White House 25% tariff plan for steel and aluminium is global and causing huge angst.
Experts say a long-term domestic rebalance, revitalising the American industrial sector, will take many years and is not guaranteed.
But upending the status quo and disrupting established supply chains risks significant short and medium-term disruption, both at source and destination.
The foreign aluminium arriving at Ravenswood’s Constellium plant to be pressed will now cost 25% more – a hike in price which Mr Germain says his firm can ride out to achieve the longer-term rebalance.
“I’m not going to say that an increase in cost is a good thing for customers. But I think it’s important to look at things and put them in proportion…” he says.
Proportion is not a luxury all can afford. 250 miles to the east, in Washington DC and just four miles from the frenetic policy decisions at the White House, the Right Proper Brewing Company is a dream realised for Thor Cheston.
Thor shows me around his small warehouse-based business that is clearly thriving.
He takes me to the grain silos around the back. The grain is from Canada.
Thor relies on an international supply chain – the cans are aluminium and from Canada too. Some of the malt is from Germany and from Britain.
It is a complex global web of manufacturing to make American beer. Margins are tight.
“We don’t have the luxury of just raising our prices. We’re in a competitive landscape,” Thor says. Competition with big breweries, who can more easily absorb increased costs.
The cans will probably go up in price on his next order. He doesn’t yet know how much of the 25% will be passed on to him by his supplier.
“We’ve dealt with major problems like this before. We’ve had to pivot a lot. We have survived the global pandemic. We’ve done it before, but we don’t want to. We just need a break.”
What about the government’s argument to ‘buy American’?
“It’s not as simple as that,” Thor says.
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Will there be impacts from Trump’s latest tariffs?
Back in West Virginia the mighty Ohio River snakes past the Ravenswood factories.
It still carries what’s left of America’s heavy industry. A vast multi-vessel barge full of coal passed as I chatted to locals in the nearby town of Parkersburg, a pleasant place but not the thriving industrial community it once was.
“We used to have a really nice aluminium plant right down the river here and it shut down,” one resident reflects in a passing conversation.
Here you can see why many rolled the dice for Trump.
Image: Sam Cumpstone said Obama ruined lives in West Virginia by shutting down mines
“In West Virginia, we’re big on coal,” Sam Cumpstone tells me.
He works in the railways to transport coal. The industry went through economic devastation in the late noughties, the closure of hundreds of mines causing huge unemployment.
Sam is clear on who he blames: “Obama shut down mines and made ghost towns in West Virginia. It ruined a lot of people’s lives.”
There is recognition here that Trump’s sweeping economic plans could cause prices to rise, at least in the short term. But for Trump voter Kathy Marcum, the pain would be worth it.
Image: Trump supporter Kathy Marcum believes tariffs are the way forward
“He’s putting tariffs on other countries that bring their things in, and that way it equals out. It has to be even-stevens as far as I’m concerned… He is a smart businessman. He knows what the hell he’s talking about.
“It might be rough for a little while, but in the long run I think it will be best for the country.”
Communities have been let down over generations – either by politicians or by inevitable globalisation. There is still deep scepticism here.
“No politician worth millions or billions of dollars cares about me or you. Nobody,” Sam tells me at the end of our conversation.
The Trump tariff blueprint is full of jeopardy. If it fails, it will be places like West Virginia, that will be hit hardest again.
ARLINGTON, Texas — Boston Red Sox designated hitter Rafael Devers became the first major leaguer to strike out 12 times in a season’s first four games.
Devers went 0-for-4 with two more strikeouts Sunday in Boston’s 3-2 loss to the Texas Rangers.
He’s 0-for-16, though he did draw a two-out walk in the ninth Sunday to keep the inning alive and put the potential tying run in scoring position.
The 12 strikeouts broke the previous record of 11 in the first four games, which had been done four times previously since 1901, according to SportRadar.
Brent Rooker of the Athletics struck out 11 times to open last season. The others were Atlanta’s Ronald Acuña Jr. in 2020, Minnesota’s Byron Buxton in 2017 and Houston’s Brett Wallace in 2013.
Devers is now solely the Red Sox DH after their offseason acquisition of third baseman Alex Bregman.
MARTINSVILLE, Va. — Denny Hamlin ended an agonizing 10-year winless streak at Martinsville Speedway, holding off teammate Christopher Bell in his home state.
The Joe Gibbs Racing star, who was raised a few hours away in the Richmond suburb of Chesterfield, leads active Cup drivers with six victories at Martinsville. But Sunday was Hamlin’s first checkered flag on the 0.526-mile oval in southwest Virginia since March 29, 2015 and also his first with crew chief Chris Gayle, who joined the No. 11 team this season.
With the 55th victory of his career (tying NASCAR Hall of Famer Rusty Wallace for 11th on the all-time list), Hamlin also snapped a 31-race winless streak since last April at Dover. He led a race-high 274 of the final 275 laps after taking the lead from Chase Elliott.
“Chris Gayle, all the engineers, the pit crew, everybody really just deciding they were going to come here with a different approach than what we’ve been over the last few years,” said Hamlin, who was a frequent contender during his 19-race win drought at Martinsville with 10 top fives. “It was just amazing. The car was great. It did everything I needed it do to. Just so happy to win with Chris, get 55. Gosh, I love winning here.”
Bell, who leads the Cup Series with three wins in 2025, finished second after starting from the pole position, and Bubba Wallace took third as Toyotas swept the top three. The Chevrolets of Elliott and Kyle Larson rounded out the top five.
“It was a great weekend for Joe Gibbs Racing,” said Bell, who had finished outside the top 10 the past two weeks. “Showed a lot of pace. All four of the cars were really good. Really happy to get back up front. The last two weeks have been rough for this 20 team. Really happy for Denny. He’s the Martinsville master. Second is not that bad.”
Hamlin had to survive four restarts — and a few strong challenges from Bell — in the final 125 laps as Martinsville produced the typical short-track skirmishes between several drivers.
The most notable multicar accident involved Toyota drivers Ty Gibbs and Tyler Reddick, who had a civil postrace discussion in the pits.
Bubba’s big day Bubba Wallace tied a season best and improved to eighth in the Cup points standings but was left lamenting his lack of speed on restarts after being unable to pressure Hamlin.
“I’m trying to scratch my head on what I could have done different,” said Wallace, who drives the No. 23 Toyota for the 23XI Racing team co-owned by Hamlin and NBA legend Michael Jordan. “My restarts were terrible. One of my best traits, so I need to go back and study that. The final restart, I let that second get away. I don’t know if I had anything for Denny. It would have been fun to try. But all in all, a hell of a day for Toyota.”
Special day turns sour
After being honored Sunday morning with a Virginia General Assembly proclamation commending Wood Brothers Racing’s 75th anniversary, Josh Berry led 40 laps in the team’s hometown race before disaster struck. Berry’s No. 21 Ford was hit in the left rear by the No. 23 Toyota of Wallace while exiting the pits, causing Berry’s car to stall in Turn 2.
Berry, who can withstand a poor finish because his Las Vegas victory qualified him for the playoffs, returned after losing two laps for repairs. He still managed to lead the most laps for Wood Brothers Racing at Martinsville since NASCAR Hall of Famer David Pearson led 180 on April 29, 1973 (the team’s most recent victory at the track just east of its museum in Stuart, Virginia).
Up next
The Cup Series will race next Sunday at historic Darlington Raceway, the South Carolina track that will celebrate a “throwback weekend” that encourages teams to feature vintage paint schemes and crew uniforms.
It’s the first of two annual races on the 1.366-mile oval that dates to 1950. Brad Keselowski won last year’s throwback race, and Chase Briscoe won the Southern 500 last September.