Background: The aims of this study were to: (I) evaluate the effect of a nine-week guided Internet-based Cognitive Behavioral Therapy (ICBT) program on depressive symptoms (DS) in patients with HF; (II) to assess factors associated with the change in DS; and (III) to investigate the effect of the ICBT program on cardiac anxiety and QoL.

Methods: Fifty participants were included and randomized into two treatment arms: ICBT or an online moderated discussion forum (DF). Data were collected at baseline and at the nine-week follow-up; the Patient Health Questionnaire- nine, (DS); the Cardiac Anxiety Questionnaire, (cardiac-related anxiety); the Minnesota Living with Heart Failure questionnaire, (QoL). Intention to treat analysis was used. Between group differences were determined by analysis of covariance.

Results: In the ICBT-group (n=25), DS improved significantly (P=.02). Also cardiac anxiety in the subscale of fear decreased significantly (P=.04) between baseline and the follow up in the ICBT-group. QoL improved in the ICBT-group by 6 points in the total score and 2.4 points in the physical factor, but this was not significant (P=.09 and P=.12). In the DF-group (n=25) no significant change in the level of DS was found (P=.36). There were no significant differences in the change in DS between the DF- and the ICBT-group (P=.21), nor in cardiac related anxiety (P=.22) or in QoL (total score P=.09, physical factor P=.07). In the ICBT-group, the number of logins to the web-portal correlated significantly with improvement in DS (P=.02), whereas higher age (P=.01) and male sex (P=.048) were associated with less change in DS.

Conclusions: Guided ICBT adapted for persons with HF and DS can potentially reduce DS, cardiac anxiety and increase QoL, but is not statistically superior to participation in an online DF.