Utility of collagen-derived peptides as markers of organ injury in patients with acute heart failure

ObjectiveThis study aims to investigate the time-dependent prognostic utility of two fibrosis markers representing organ fibrogenesis (N-terminal propeptide of procollagen III (PIIINP) and type IV collagen 7S (P4NP 7S)) in patients with acute heart failure (HF).Methods390 patients with acute HF were dichotomised based on the median value of fibrosis markers at discharge. The primary outcome measure was a composite of cardiac death and HF hospitalisation.ResultsP4NP 7S significantly declined during hospitalisation, whereas PIIINP did not. The cumulative 90-day and 365-day incidence of the primary outcome measure was 16.6% vs 16.0% (p=0.42) and 33.3% vs 28.4% (p=0.34) in the patients with high versus low PIIINP; 19.9% vs 13.0% (p=0.04) and 32.3% vs 29.0% (p=0.34) in the patients with high and low P4NP 7S, respectively. After adjusting for confounders, high P4NP 7S correlated with significant excess risk relative to low P4NP 7S for both 90-day and 365-day primary outcome measure (adjusted HR, 1.50; 95% CI, 1.02 to 2.21; p=0.04 and adjusted HR, 1.89; 95% CI, 1.11 to 3.26; p=0.02, respectively), which was driven by significant association of high P4NP 7S with higher incidence of HF hospitalisation. Furthermore, P4NP 7S exhibited an additive value to conventional prognostic factors for predicting 90-day outcome (p=0.038 for net reclassification improvement; p=0.0068 for integrated discrimination improvement). High PIIINP did not correlate with significant excess risk for both 90-day and 365-day outcome.ConclusionsThis study suggests a possible role of P4NP 7S in the risk stratification of patients with acute HF.

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P6359Utility of collagen-derived peptides as markers of organ injury in patients with acute heart failure: a prospective cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz746.0955 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Maruichi ◽

K Nagao ◽

T Inada ◽

Y Sato ◽

R Hata ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Cardiac Death ◽

Primary Outcome ◽

Outcome Measure ◽

Primary Outcome Measure ◽

Excess Risk ◽

Organ Injury ◽

Significant Excess ◽

Significant Excess Risk

Abstract Background Organ injury in heart failure (HF) might evoke profibrotic response, which might adversely affect prognosis.In patients with HF, liver fibrogenesis marker, type IV collagen 7S (P4NP 7S), correlates with pulmonary artery pressure and right-side cardiac pressure such as right atrial and ventricular pressure. The present study aimed to investigate the prognostic utility of two collagen markers (N-terminal propeptide of procollagen III [PIIINP] and P4NP 7S) in patients with acute HF. Methods and results We conducted a prospective cohort study including 390 patients admitted for HF to three territorial hospitals. The pre-specified primary outcome measure was cardiac death and HF hospitalization at early (90-day) and late (365-day) post-discharge period. Follow-up ratio was 99% at 90 day and 97% at 365 day, respectively. Cardiac death and HF hospitalization occurred in 61 and 114 patients at 90 days and 365 days, respectively. The dichotomization the patients based on the median value of the collagen marker at discharge revealed that patients with high P4NP 7S correlated with significant excess risk relative to those with low P4NP 7S for 90-day (adjusted hazard ratio [HR]; 1.89, 95% confidence interval [CI]); 1.11–3.26, P=0.02) and 365-day (adjusted HR; 1.50, 95% CI; 1.02–2.21, P=0.04) outcome. 10% increase in P4NP 7S was associated with 8% increase for primary outcome measure at 90 day (P=0.04). P4NP 7S showed incremental prognostic value on top of the conventional prognostic factors including age, sex, estimated glomerular filtration rate (eGFR), ejection fraction (EF) <40%, B-type natriuretic peptide (BNP), hemoglobin and sodium <140mmol/L (P=0.038 for net reclassification improvement, P=0.0068 for integrated discrimination improvement). PIIINP weakly correlated with P4NP 7S (Spearman's r=0.24, P<0.0001), but it neither correrated with the marked excess risk not associated with significant excess risk for 90 and 365-day primary outcome measure nor enhanced the discrimination. Conclusions This study suggests a possible role of P4NP 7S in the risk stratification of patients with acute HF. Acknowledgement/Funding None

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Association of an increase in serum albumin levels with positive 1-year outcomes in acute decompensated heart failure: A cohort study

PLoS ONE ◽

10.1371/journal.pone.0243818 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243818

Author(s):

Takao Kato ◽

Hidenori Yaku ◽

Takeshi Morimoto ◽

Yasutaka Inuzuka ◽

Yodo Tamaki ◽

...

Keyword(s):

Heart Failure ◽

Serum Albumin ◽

Acute Heart Failure ◽

Primary Outcome ◽

Outcome Measure ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Primary Outcome Measure ◽

Favorable Effect

Background Despite the prognostic importance of hypoalbuminemia, the prognostic implication of a change in albumin levels has not been fully investigated during hospitalization in patients with acute decompensated heart failure (ADHF). Methods Using the data from the Kyoto Congestive Heart Failure registry on 3160 patients who were discharged alive for acute heart failure hospitalization and in whom the change in albumin levels was calculated at discharge, we evaluated the association with an increase in serum albumin levels from admission to discharge and clinical outcomes by a multivariable Cox hazard model. The primary outcome measure was a composite of all-cause death or hospitalization for heart failure. Findings Patients with increased albumin levels (N = 1083, 34.3%) were younger and less often had smaller body mass index and renal dysfunction than those with no increase in albumin levels (N = 2077, 65.7%). Median follow-up was 475 days with a 96% 1-year follow-up rate. Relative to the group with no increase in albumin levels, the lower risk of the increased albumin group remained significant for the primary outcome measure (hazard ratio: 0.78, 95% confidence interval: 0.69–0.90: P = 0.0004) after adjusting for confounders including baseline albumin levels. When stratified by the quartiles of baseline albumin levels, the favorable effect of increased albumin was more pronounced in the lower quartiles of albumin levels, but without a significant interaction effect (interaction P = 0.49). Conclusions Independent of baseline albumin levels, an increase in albumin during index hospitalization was associated with a lower 1-year risk for a composite of all-cause death and hospitalization in patients with acute heart failure.

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Clinical impact of left and right axis deviations with narrow QRS complex on 3-year outcomes in a hospital-based population in Japan

Scientific Reports ◽

10.1038/s41598-021-88259-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yuta Seko ◽

Takao Kato ◽

Yuhei Yamaji ◽

Yoshisumi Haruna ◽

Eisaku Nakane ◽

...

Keyword(s):

Cardiovascular Events ◽

Primary Outcome ◽

Outcome Measure ◽

Conduction Block ◽

Primary Outcome Measure ◽

Excess Risk ◽

Major Adverse Cardiovascular Events ◽

Prognostic Impact ◽

Axis Deviation ◽

The Right

AbstractWhile the prognostic impact of QRS axis deviation has been assessed, it has never been investigated in patients without conduction block. Thus, we evaluated the prognostic impact of QRS-axis deviation in patients without conduction block. We retrospectively analyzed 3353 patients who had undergone both scheduled transthoracic echocardiography and electrocardiography in 2013 in a hospital-based population, after excluding patients with a QRS duration of ≥ 110 ms, pacemaker placement, and an QRS-axis − 90° to − 180° (northwest axis). The study population was categorized into three groups depending on the mean frontal plane QRS axis as follows: patients with left axis deviation (N = 171), those with right axis deviation (N = 94), and those with normal axis (N = 3088). The primary outcome was a composite of all-cause death and major adverse cardiovascular events. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the left axis deviation group (26.4% in the left axis deviation, 22.7% in the right axis deviation, and 18.4% in the normal axis groups, log-rank P = 0.004). After adjusting for confounders, the excess risk of primary outcome measure remained significant in the left axis deviation group (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.07–1.95; P = 0.02), while the excess risk of primary outcome measure was not significant in the right axis deviation group (HR 1.22; 95% CI 0.76–1.96; P = 0.41). Left axis deviation was associated with a higher risk of a composite of all-cause death and major adverse cardiovascular events in hospital-based patients without conduction block in Japan.

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1136Prognostic impact of mineralocorticoid receptor antagonists in patients hospitalized for acute heart failure

European Heart Journal ◽

10.1093/eurheartj/ehz748.0005 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Yaku ◽

T Kato ◽

T Morimoto ◽

Y Inuzuka ◽

Y Tamaki ◽

...

Keyword(s):

Heart Failure ◽

Lower Risk ◽

Mineralocorticoid Receptor ◽

Primary Outcome ◽

Outcome Measure ◽

Primary Outcome Measure ◽

Matched Cohort ◽

Mineralocorticoid Receptor Antagonists ◽

Receptor Antagonists

Abstract Background The favourable effect of mineralocorticoid receptor antagonists (MRAs) on mortality was established in patients with stable heart failure (HF) with reduced ejection fraction (EF). However, its prognostic effect of MRAs in acute decompensated heart failure (ADHF) including HF with preserved EF (HFpEF) was unclear. Purpose This study sought to investigate the long-term impact of MRA on the post-discharge outcomes in patients with ADHF. Methods From the consecutive 3717 patients hospitalized for ADHF and discharged alive in the KCHF registry, we developed the propensity score (PS) for MRA use and constructed the PS-matched cohort. We compared the effect of MRA use on the primary outcome measure of all-cause death or HF hospitalization. Results A total of 1678 patients (45%) received MRA at discharge from the index hospitalization. Median follow-up was 470 days with 96% 1-year follow-up rate. In the PS-matched cohort (N=1034 in each group), the cumulative 1-year incidence of the primary outcome measure was significantly lower in the MRA group than in the no MRA group (28.4% vs. 33.9%, P=0.003) (Figure 1). The cumulative 1-year incidence of HF hospitalization was significantly lower in the MRA group than in the no MRA group (18.7% vs. 24.8%, P<0.001), while there was no difference in mortality between the 2 groups (15.6% vs. 15.8%, P=0.85). There was no interaction between the effect of MRA and the 3 subgroups stratified by EF (EF <40%, EF 40–49%, EF ≥50%) (interaction P=0.12). Figure 1 Conclusion The use of MRA was associated with lower risk for the primary composite outcome of all-cause death or HF hospitalization in patients hospitalized for ADHF including HFpEF, which was mainly driven by the lower risk for HF hospitalization.

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Prognostic value of reduction in left atrial size during a follow-up of heart failure: an observational study

BMJ Open ◽

10.1136/bmjopen-2020-044409 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044409

Author(s):

Masayuki Shiba ◽

Takao Kato ◽

Takeshi Morimoto ◽

Hidenori Yaku ◽

Yasutaka Inuzuka ◽

...

Keyword(s):

Heart Failure ◽

Lower Risk ◽

Left Atrial ◽

Primary Outcome ◽

Outcome Measure ◽

No Reduction ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Group Change

ObjectiveThe association between sequential changes in left atrial diameter (LAD) and prognosis in heart failure (HF) remains to be elucidated. The present study aimed to investigate the link between reduction in LAD and clinical outcomes in patients with HF.DesignA multicentre prospective cohort study.SettingThis study was nested from the Kyoto Congestive Heart Failure registry including consecutive patients admitted for acute decompensated heart failure (ADHF) in 19 hospitals throughout Japan.ParticipantsThe current study population included 673 patients with HF who underwent both baseline and 6-month follow-up echocardiography with available paired LAD data. We divided them into two groups: the reduction in the LAD group (change <0 mm) (n=398) and the no-reduction in the LAD group (change ≥0 mm) (n=275).Primary and secondary outcomesThe primary outcome measure was a composite of all-cause death or hospitalisation for HF during 180 days after 6-month follow-up echocardiography. The secondary outcome measures were defined as the individual components of the primary composite outcome measure and a composite of cardiovascular death or hospitalisation for HF.ResultsThe cumulative 180-day incidence of the primary outcome measure was significantly lower in the reduction in the LAD group than in the no-reduction in the LAD group (13.3% vs 22.2%, p=0.002). Even after adjusting 15 confounders, the lower risk of reduction in LAD relative to no-reduction in LAD for the primary outcome measure remained significant (HR 0.59, 95% CI 0.36 to 0.97 p=0.04).ConclusionPatients with reduction in LAD during follow-up after ADHF hospitalisation had a lower risk for a composite endpoint of all-cause death or HF hospitalisation, suggesting that the change of LAD might be a simple and useful echocardiographic marker during follow-up.

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A decrease in tricuspid regurgitation pressure gradient during follow-up in patients with heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.1015 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Seko ◽

T Kato ◽

E Yamamoto ◽

H Yaku ◽

T Morimoto ◽

...

Keyword(s):

Heart Failure ◽

Pressure Gradient ◽

Tricuspid Regurgitation ◽

Primary Outcome ◽

Outcome Measure ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Primary Outcome Measure ◽

Prognostic Impact

Abstract Objective This study aimed to investigate the prognostic impact of the decrease in tricuspid regurgitation pressure gradient (TRPG) at 6-month follow-up in patients after discharge with heart failure (HF). Background No previous study has reported the association between TRPG decrease during follow-up and clinical outcomes in HF. Methods Among 748 patients with 6-months follow-up echocardiography after discharge from the acute decompensated heart failure in 19 centers in Japan, we analyzed 721 patients with available TRPG data and divided into two groups: the decrease in TRPG group (N=179) and no decrease in TRPG group (N=542). We defined the decrease in TRPG as >10mmHg decrease compared in the initial hospitalization. The primary outcome measure was a composite of all cause deaths and hospitalization due to HF. Results The patients in the decrease in TRPG group had a lower prevalence of hypertension, dyslipidemia, atrial fibrillation, and a reduced EF, higher levels of blood albumin and lower levels of sodium than those in no decrease in TRPG group. The median follow-up duration after the follow up echocardiography was 302 (inter quartile range: 206–490), with a 90.9% follow up rate at 6-month. The cumulative 6-month incidence of the primary outcome measure was significantly lower in the decrease in TRPG group than in no decrease in TRPG group (12.2% vs. 18.9%, P=0.0011). After adjusting confounders, the excess risk of the decrease in TRPG relative to no decrease in TRPG for the primary outcome measure remained significant (HR: 0.60, 95% CI 0.34–0.99). There were no significant interactions between the subgroup factors and the effect of the decrease in TRPG for primary outcomes. Conclusions HF patients with the decrease in TRPG at 6-month after discharge had a lower risk of clinical outcome than those without decrease in TRPG. Funding Acknowledgement Type of funding source: None

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Abstract 14922: Association of Increase of Serum Albumin Levels During Hospitalization With 1-year Outcomes for Acute Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.14922 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Takao Kato ◽

Hidenori Yaku ◽

Neiko Ozasa ◽

Erika Yamamoto ◽

YASUTAKA INUZUKA ◽

...

Keyword(s):

Heart Failure ◽

Serum Albumin ◽

Acute Heart Failure ◽

Primary Outcome ◽

Primary Outcome Measure ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Interaction Interaction ◽

Primary Composite Outcome

Introduction: Hypoalbuminemia is a well-known prognostic factor in acute heart failure (AHF). Hypothesis: We hypothesized that there is an favorable association of the increase in serum albumin levels during hospitalization with 1-year clinical outcomes in patients hospitalized for AHF. Methods: Using the data of the consecutive 3717 patients hospitalized for AHF and discharged alive in the Kyoto Congestive Heart Failure registry, we evaluated the baseline and therapeutic factors associated with the increase of serum albumin levels during hospitalization for AHF. Next, we compared the effect of increase of albumin for the primary composite outcome measures compromising all-cause death and HF hospitalization using a Cox proportional hazard model. Results: The patients in the increase of albumin group (N=1083, 34%) were younger and less likely to have a larger body mass index and renal dysfunction than those in the non-increase group (N=2077, 66%). Median follow-up was 470 days with 96% 1-year follow-up rate. The risk for the primary outcome measure in the increase group relative to the non-increase group was significantly low (adjusted hazard ratio [HR]: 0.78, 95% confidence interval [CI]: 0.69-0.90: P=0.0004) after adjusting confounders including baseline albumin levels. When stratified by the quartiles of albumin levels at discharge, the trend was more evident in the lower quartiles of albumin levels but without interaction (interaction P=0.38). Conclusions: The increase of albumin was associated with lower 1-year risk for the composite of all-cause death and HF hospitalization in patients with hospitalized AHF, independently of baseline albumin levels.

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P772Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for heart failure patients with different left ventricular ejection fraction categories: from the KCHF Registry

European Heart Journal ◽

10.1093/eurheartj/ehz747.0372 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y Yoshikawa ◽

Y Tamaki ◽

H Yaku ◽

E Yamamoto ◽

N Ozasa ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Primary Outcome ◽

Outcome Measure ◽

Primary Outcome Measure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

P Value ◽

Ventricular Ejection Fraction ◽

Hazard Ratios

Abstract Background The current guidelines recommend different medical treatment strategies for heart failure (HF) patients according to category of left ventricular ejection fraction (LVEF). Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB) is an established medical treatment for heart failure with reduced ejection fraction (HFrEF), whereas its usefulness remains to be elucidated for non-HFrEF, especially for heart failure with mid-range ejection fraction (HFmrEF). Purpose This study aimed to assess the difference in association between ACE-I/ARB and clinical outcomes depending on LVEF category. Methods The Kyoto Congestive Heart Failure (KCHF) Registry is a multicentre registry without any exclusion criteria which included consecutive patients hospitalized for congestive HF in Japan. In each LVEF group (HFrEF, HFmrEF and heart failure with preserved ejection fraction [HFpEF]), we compared those who were prescribed ACE-I/ARB as discharge medication and those not, and assessed their 1-year clinical outcomes. We defined the primary outcome measure as a composite of all-cause death and HF hospitalization. We constructed a multivariable Cox regression model incorporating 24 clinically relevant factors. We assessed adjusted hazard ratios (HRs) of those with ACE-I/ARB relative to those not, and also interaction between ACE-I/ARB prescription at discharge and LVEF category. Results A total of 3717 patients were included in this study, where the number of patients in each LVEF group were as follows; 1383 patients with HFrEF, 703 with HFmrEF and 1631 with HFpEF, respectively (Figure). As shown in the table, the HRs for the primary outcome measure were significant in the HFrEF and HFmrEF groups, whereas the HR in the HFpEF group was insignificant. The interaction between ACE-I/ARB prescription and LVEF category for the primary outcome measure was statistically significant. Hazard ratios by LVEF category Outcome measures HFrEF HFmrEF HFpEF P interaction HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value All-cause death + HF hospitalization 0.66 (0.54–0.79) <0.001 0.61 (0.45–0.82) 0.001 0.95 (0.80–1.14) 0.61 0.01 All-cause death 0.62 (0.48–0.81) <0.001 0.52 (0.35–0.77) 0.001 0.73 (0.58–0.93) 0.01 0.10 HF hospitalization 0.73 (0.57–0.92) 0.009 0.59 (0.40–0.87) 0.007 1.14 (0.90–1.44) 0.28 0.07 Hazard ratios of ACE-I/ARB relative to non-ACE-I/ARB for primary outcome measures in each LVEF category. Study flowchart Conclusions The risk ratios of those who were prescribed ACE-I/ARB relative to those not were significantly low in HFmrEF as well as HFrEF, whereas the risk ratios were insignificant in HFpEF. ACE-I/ARB could be a potential choice of treatment for HFmrEF patients.

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Prognostic role of sonographic decongestion in patients with acute heart failure with reduced and preserved ejection fraction: a multicentre study

European Heart Journal ◽

10.1093/ehjci/ehaa946.1219 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N.R Pugliese ◽

M Mazzola ◽

G Bandini ◽

G Barbieri ◽

S Spinelli ◽

...

Keyword(s):

Heart Failure ◽

Adverse Events ◽

Ejection Fraction ◽

Acute Heart Failure ◽

Vena Cava ◽

Composite Endpoint ◽

Clinical Findings ◽

Preserved Ejection Fraction ◽

Net Reclassification Improvement ◽

B Lines

Abstract Aims Our aim was to assess the dynamic changes of pulmonary congestion (PC) through variations of sonographic B-lines, in addition to conventional clinical, biohumoral and echocardiographic findings, to improve prognostic stratification of patients admitted for acute heart failure with reduced and preserved ejection fraction (HFrEF, HFpEF). Methods In this multicenter, prospective, observational study, lung ultrasound was performed in all patients at admission and before discharge by trained investigators, blinded to clinical findings and outcomes. Results We enrolled 208 consecutive patients admitted for acute heart failure (125 HFrEF, 83 HFpEF, mean age 75.9±11.7 years, 36% females, mean ejection fraction 38%). After 180-day follow-up, 38 composite endpoint events occurred (cardiovascular deaths or HF re-hospitalisations). In a multivariate model, B-lines at discharge had independent prognostic value in the overall population together with NT-proBNP, moderate-to-severe mitral regurgitation (MR) and inferior vena cava diameter at admission. When dividing the population in HFrEF and HFpEF, B-lines at discharge was the only independent parameter to predict events in all subgroups. At ROC analysis, a cut-off of B-lines>15 at discharge displayed the highest accuracy in predicting adverse events (AUC=0.80, p<0.0001). The identification of patients unable to halve B-lines during hospitalization (ΔB-lines%), in addition to B-lines >15 at discharge, improved event classification (integrated discrimination improvement=4%, p=0.01; continuous net reclassification improvement=22.8%, p=0.04). Conclusions The presence of residual subclinical sonographic PC at discharge predicts adverse events in the whole spectrum of acute HF patients, independently of conventional biohumoral and echocardiographic parameters. The dynamic evaluation of pulmonary decongestion during hospital stay can further improve patient risk stratification. Funding Acknowledgement Type of funding source: None

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Computerised cognitive–behavioural therapy for adults with intellectual disability: randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.117.198630 ◽

2017 ◽

Vol 211 (2) ◽

pp. 95-102 ◽

Cited By ~ 13

Author(s):

Patricia Cooney ◽

Catherine Jackman ◽

David Coyle ◽

Gary O'Reilly

Keyword(s):

Intellectual Disability ◽

Randomised Controlled Trial ◽

Primary Outcome ◽

Outcome Measure ◽

Controlled Trial ◽

Behavioural Therapy ◽

Primary Outcome Measure ◽

Cognitive Behavioural ◽

Randomised Controlled

BackgroundDespite the evidence base for computer-assisted cognitive–behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability.AimsTo evaluate the utility of a CBT computer game for adults who have an intellectual disability.MethodA 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis.ResultsA significant group x time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU.ConclusionsAs the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.

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