Antidepressant Use and Rehospitalization: Fact Versus Fiction

Congestive heart failure (CHF) affects more than 5.7 million adults in the U.S., and less than half of those with CHF survive more than five years after diagnosis, reports the Centers for Disease Control and Prevention (CDC). Yet, the mortality of CHF only increases with age and the presence of other underlying health conditions. Rather than giving up, researchers and senior caregivers are focusing on how to help those with CHF live longer, healthier lives.

Part of the conversation and fight against CHF among seniors focuses on reducing the exacerbation of symptoms. Often, seniors who are hospitalized for CHF face more challenges at discharge than while in the hospital.

Medication regimens may change. Physicians may request updated lab work or schedule future visits, and senior caregivers are left to put the pieces of the puzzle together to produce a healthier future for seniors in their care. However, understanding best practices for managing CHF is critical to putting the puzzle together successfully.

What’s Happening With Antidepressant Recommendations?

Previously, antidepressants were commonly prescribed to seniors discharged from hospitals with CHF. The thinking behind this measure was reduced depression would encourage seniors to stay active and take a position on improving their health, explains a report in Science Daily. Much debate on this practice existed, and as a result, researchers devised a study to determine if antidepressants were as effective at reducing immediate mortality risk as some claimed.

Researchers studies 372 participants with impaired heart function and depression. Over the course of 24 months, the participants were split into two groups. One group received an antidepressant, and the other group was given a placebo. Both groups continued to receive standard heart therapy measures, such as low-sodium diets and physical therapy. Participants in both groups exhibited nearly identical rates of rehospitalization, worsening health or even death.

Due to the high similarity between both groups, researchers concluded the use of antidepressants does not support claims of reduced risk for rehospitalization. As a result, those who have previously been on antidepressant regimens after discharge from a hospital for CHF could actually be causing more harm than good. Essentially, the cocktail of antidepressants with CHF medications could result in unnecessary side effects.

Retraining on Medication Standards After Hospitalization for CHF Is Necessary

The use of antidepressants in treating post-discharge seniors for CHF has been the standard for many years. Therefore, the training of your staff in your facility may be outdated and reflect the previous standards for CHF. Moreover, unlicensed staff, such as nursing assistants and home health aides, may be unware of existing medication recommendations for seniors with CHF. The only way to ensure all staff understands how these new recommendations will impact their job duties is providing additional training.

Your senior caregiver training could be as simple as a printed in-service or a detailed presentation with information from the American Heart Association (AHA). For senior caregivers who maintain professional licensure, such as Registered Nurses, a more comprehensive training may be necessary.

For example, you may disperse post-discharge assessment packets, which are available online via the AHA, for use in all cases where a senior with CHF returns from a hospital. While these packets are designed for use by hospital staff, they can help you prevent rehospitalization by learning what to follow up with after discharge, such as pneumonia vaccines or additional appointments. Ultimately, identifying these factors now will help you avoid costs and unnecessary delays in providing the best quality of care to seniors with CHF.

Additional Best Practices for Reducing Rehospitalization of Seniors With CHF

Reducing the risk of rehospitalization of seniors with CHF is not as simple as administering medication. It is an involved, detailed and ongoing process. As explained by European Heart Journal, managing chronic heart failure is a team effort, and you can enhance outcomes and reduce rehospitalization through the following best practices:

• Control Other Medical Conditions. Co-existing medical conditions, such as diabetes, high blood pressure, history of stroke and chronic kidney disease, can increase the strain on the heart. A senior care team should manage all of the conditions concurrently.
• Provide a Strong Support Network. A senior support network is made up of the CHF managing team and the family members and friends of each senior. Encourage participation in senior care among all parts of the support network. This will help to prevent psychological distress from a CHF diagnosis or exacerbation.
• Educate Seniors and Their Families About Expectations for CHF. Setting realistic expectations for the prognosis of CHF among seniors is critical to encouraging longevity and reducing the risk for rehospitalization. Educate seniors and family members about how CHF will impact daily living, and use the time as an opportunity to encourage adherence to these best practices to reduce complications.
• Make Dietary Changes to Reduce Strain on the Heart. A heart-healthy diet is essential to preventing the buildup of pressure on a poorly-functioning heart. Teach seniors with CHF and their family members to avoid bringing or preparing high-sodium foods for seniors with this ailment. Furthermore, reducing the consumption of fats will help reduce risk of rehospitalization as well.
• Encourage Physical Activity. Regardless of statistics, seniors with CHF must not give in to a sedentary lifestyle. In other words, seniors with CHF should be encouraged to engage in as much physical activity as reasonably possible. This can be as simple as walking with seniors to improve circulation.
• Take Medications as Prescribed. The best-laid plans for managing CHF in seniors are ineffective if not adhered to, and taking medications as prescribed is essential to maximizing longevity and reducing the exacerbation of symptoms, which is especially important for seniors taking medications to control other medical conditions.

The changes in recommendations for the use of antidepressants are a small part in the big picture of managing CHF, but changing practices can be frightening. Rather than believe seniors in your care with CHF have to be resigned to frequent rehospitalization, help your staff understand how changes in these best practices for managing CHF in seniors can go much further than you may realize.