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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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Entertainment

Gary Lineker says ‘right time’ to leave Match Of The Day as he hints of changes to show’s format

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Gary Lineker says 'right time' to leave Match Of The Day as he hints of changes to show's format

Gary Lineker has said it is “the right time” to leave Match Of The Day and hinted the BBC could change the format of the Premier League highlights show.

The 63-year-old will step down as host at the end of the season and described his time on the show as an “absolute joy and privilege”.

Speaking on his podcast, The Rest Is Football, he said: “It has been an absolute joy and privilege to present such an iconic show for the BBC.

“But all things have to come to an end.”

Lineker went on to say the broadcaster enters a new three-year deal to host top-flight highlights, and that to stay on for another 12 months “would be a bit weird”.

“I think the next contract they’re looking to do Match Of The Day slightly differently, so I think it makes sense for someone else to take the helm.

“I bowed out in my football career when I felt it was the right time. I feel this is now the right time.”

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Lineker refused to speculate who would be taking his place, as rumours grew around Mark Chapman, the regular Match Of The Day 2 presenter, Football Focus host Alex Scott, and BBC sports coverage presenter Gabby Logan.

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“Obviously I don’t know who it’ll be, and I would never tell publicly my preference, I don’t think that’d be the right thing to do – but whoever it is, I would say be yourself,” he said.

“I had to fill the ginormous shoes of certain Des Lynam.

“…I would say just be yourself and enjoy it, it’s a wonderful programme to be a part of. It was brilliant before I took over, and it will be brilliant after I leave.”

Lineker pictured with former MOTD host Des Lynam in 2009. Pic: PA
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Lineker pictured with former MOTD host Des Lynam in 2009. Pic: PA

Lineker has hosted Match Of The Day since 1999 and will have presented the show for more than a quarter of a century when he leaves in May 2025.

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He will continue with the MOTD Top Ten podcast alongside his podcast, which also features BBC pundits Alan Shearer and Micah Richards.

The former England striker has been the BBC’s highest-paid on-air talent for seven consecutive years and was estimated to have earned £1.35m in the year 2023/24.

The BBC said future plans for Match Of The Day would be “announced in due course”.

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Business

UK economy grows by 0.1% between July and September – slower than expected

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UK economy grows by 0.1% between July and September - slower than expected

The UK economy grew by 0.1% between July and September, according to the Office for National Statistics (ONS).

However, despite the small positive GDP growth recorded in the third quarter, the economy shrank by 0.1% in September, dragging down overall growth for the quarter.

The growth was also slower than what had been expected by experts and a drop from the 0.5% growth between April and June, the ONS said.

Economists polled by Reuters and the Bank of England had forecast an expansion of 0.2%, slowing from the rapid growth seen over the first half of 2024 when the economy was rebounding from last year’s shallow recession.

And the metric that Labour has said it is most focused on – the GDP per capita, or the economic output divided by the number of people in the country – also fell by 0.1%.

Reacting to the figures, Chancellor of the Exchequer Rachel Reeves said: “Improving economic growth is at the heart of everything I am seeking to achieve, which is why I am not satisfied with these numbers,” she said in response to the figures.

“At my budget, I took the difficult choices to fix the foundations and stabilise our public finances.

“Now we are going to deliver growth through investment and reform to create more jobs and more money in people’s pockets, get the NHS back on its feet, rebuild Britain and secure our borders in a decade of national renewal,” Ms Reeves added.

The sluggish services sector – which makes up the bulk of the British economy – was a particular drag on growth over the past three months. It expanded by 0.1%, cancelling out the 0.8% growth in the construction sector

The UK’s GDP for the the most recent quarter is lower than the 0.7% growth in the US and 0.4% in the Eurozone.

The figures have pushed the UK towards the bottom of the G7 growth table for the third quarter of the year.

It was expected to meet the same 0.2% growth figures reported in Germany and Japan – but fell below that after a slow September.

The pound remained stable following the news, hovering around $1.267. The FTSE 100, meanwhile, opened the day down by 0.4%.

The Bank of England last week predicted that Ms Reeves’s first budget as chancellor will increase inflation by up to half a percentage point over the next two years, contributing to a slower decline in interest rates than previously thought.

Announcing a widely anticipated 0.25 percentage point cut in the base rate to 4.75%, the Bank’s Monetary Policy Committee (MPC) forecast that inflation will return “sustainably” to its target of 2% in the first half of 2027, a year later than at its last meeting.

The Bank’s quarterly report found Ms Reeves’s £70bn package of tax and borrowing measures will place upward pressure on prices, as well as delivering a three-quarter point increase to GDP next year.

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US

RFK Jr chosen as Donald Trump’s health secretary – as president-elect says he will do ‘unbelievable things’

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RFK Jr chosen as Donald Trump's health secretary - as president-elect says he will do 'unbelievable things'

Donald Trump has chosen vaccine sceptic Robert F Kennedy Jr as his new health secretary and said he will do “unbelievable things”.

The news was announced by Donald Trump Jr on X, before the president-elect confirmed the appointment just moments later.

Former Democrat RFK Jr, the nephew of former president John F Kennedy, had been running as an independent presidential candidate but dropped out of the race and endorsed Mr Trump in August.

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From August: Kennedy family criticises RFK Jr after Trump endorsement

In return for Mr Kennedy’s support during the election, president-elect Trump pledged to give him a “big role” – and RFK Jr’s preference for the health position was widely reported.

Mr Trump spoke on Thursday night at a gala, hosted at his Mar-a-Lago retreat in Florida, which included tech billionaire Elon Musk and actor Sylvester Stallone.

Directly addressing RFK Jr, who was in the audience, Mr Trump said: “We want you to come up with things… and ideas… and what you’ve been talking about for a long time. I think you’re going to do some unbelievable things. Nobody’s going to be able to do it like you.”

The health and human services (HHS) department includes the Food and Drug Administration, the Centers for Disease Control and Prevention, Medicare, Medicaid and the National Institutes of Health.

RFK Jr will “restore these Agencies to the traditions of Gold Standard Scientific Research, and beacons of Transparency, to end the Chronic Disease epidemic, and to Make America Great and Healthy Again,” the president-elect wrote on X.

Donald Trump and Robert F Kennedy Jr in October during the presidential campaign. Pic: Reuters
Image:
Donald Trump and Robert F Kennedy Jr in October during the presidential campaign. Pic: Reuters

Mr Trump added: “For too long, Americans have been crushed by the industrial food complex and drug companies who have engaged in deception, misinformation, and disinformation when it comes to Public Health.

“The Safety and Health of all Americans is the most important role of any Administration.”

Mr Kennedy is a known vaccine sceptic who has repeated misinformation on multiple occasions, including the discredited theory that childhood immunisations cause autism.

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The RFK Jr-led health department will “play a big role in helping ensure that everybody will be protected from harmful chemicals, pollutants, pesticides, pharmaceutical products, and food additives that have contributed to the overwhelming Health Crisis in this Country,” the president-elect added.

Earlier, his son Donald Trump Jr was the first to confirm the appointment, writing on X: “Robert F Kennedy Jr will be The Secretary of Health and Human Services! Promises Made Promises Kept.”

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When Trump met Obama and Biden

RFK Jr’s position will need to be confirmed with a Senate vote – but even with the chamber under Republican control, his appointment may face opposition because of his views on health issues.

Before Mr Trump announced his choice, Mr Kennedy had already claimed the new president would push to remove fluoride from drinking water on his first day in office. The addition of the compound has been cited as helping to improve dental health.

The department RKF Jr is hoping to oversee has more than 80,000 employees across the United States.

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