In patients with heart failure, anxiety and depression linked to worse outcomes

July 6, 2018, Wolters Kluwer Health
Credit: CC0 Public Domain

Symptoms of depression and anxiety are present in about one-third of patients with heart failure - and these patients are at higher risk of progressive heart disease and other adverse outcomes, according to a review and update in the July/August issue of Harvard Review of Psychiatry.

Yet and anxiety remain underrecognized and undertreated in patients with , report Christopher Celano, MD, of Massachusetts General Hospital and colleagues. "Diagnosing a psychiatric illness can be challenging in view of the significant overlap" between psychiatric symptoms and those related to heart , Dr. Celano comments. Nevertheless, "making the effort can help to identify those who are at higher risk for poor cardiac outcomes and to implement the treatment of these disorders."

Depression and Anxiety in Heart Failure—Call to Improve Diagnosis and Treatment

Heart failure is a chronic, progressive condition in which the heart can't pump enough blood, causing symptoms such as fatigue and shortness of breath. Affecting more than five million Americans, heart failure causes death within five years in about 50 percent of patients.

Previous studies have linked psychiatric disorders to worse outcomes in patients with heart failure. To clarify these relationships, Dr. Celano and colleagues performed a targeted review of research on associations between heart failure, depression, and anxiety.

They found evidence confirming "markedly higher" rates of depression and anxiety disorders among patients with heart failure, compared to the general population. Studies have reported that one-third of heart failure patients report elevated symptoms of depression on standard questionnaires, while 19 percent meet diagnostic criteria for major depression or other depressive disorders.

"Depression has been linked to the development and progression of heart failure and other cardiovascular diseases," Dr. Celano and coauthors write. Studies suggest not only that heart failure patients with depression are at increased risk of death or cardiac events, but also that otherwise healthy adults with depression are more likely to develop heart failure.

Anxiety is also highly frequent among patients with heart failure: nearly 30 percent of patients have clinically significant anxiety symptoms, while 13 percent meet diagnostic criteria for anxiety (such as generalized anxiety disorder, posttraumatic stress disorder, or panic disorder). Some studies have linked anxiety to adverse heart failure outcomes, although the evidence is less consistent than for depression.

Both physiological and behavioral factors may contribute to adverse outcomes. Depression and anxiety may make it more difficult for patients with heart failure to follow recommendations for diet, exercise, and medication use. Studies have also linked depression to metabolic changes, including increased levels of inflammatory markers.

Dr. Celano and colleagues believe that formal diagnostic interviews (i.e., based on DSM-5 criteria) can help in assessing the cause of overlapping symptoms between heart failure and depression or anxiety—for example, problems with sleep, concentration, or energy.

To date, there's relatively little research to guide treatment for depression and anxiety in heart failure. Psychotherapy may offer advantages over medications; cognitive-behavioral therapy is the only type of psychotherapy specifically shown to be effective in heart failure patients. Despite a lack of specific evidence for their effectiveness in patients with heart failure, antidepressants such as selective serotonin reuptake inhibitors are recommended, with close monitoring, given their known beneficial effects when treating depression and anxiety in other populations.

The researchers emphasize the need for further research on effective treatments for the large group of with failure complicated by depression and . Dr. Celano and coauthors conclude, "It is likely that an aggressive, multimodal treatment approach—such as collaborative care models or stepped care from a mental health professional—will be needed to improve psychiatric and cardiac health in this high-risk population."

Explore further: Social isolation plus heart failure could increase hospitalizations, deaths

More information: Christopher M. Celano et al, Depression and Anxiety in Heart Failure, Harvard Review of Psychiatry (2018). DOI: 10.1097/HRP.0000000000000162

Related Stories

Social isolation plus heart failure could increase hospitalizations, deaths

May 23, 2018
Patients with heart failure who felt socially isolated were much more likely to die or be hospitalized than more socially connected patients, according to new research in Journal of the American Heart Association.

Antidepressant does not reduce hospitalization, death for HF patients with depression

June 28, 2016
In a study appearing in the June 28 issue of JAMA, Christiane E. Angermann, M.D., of University Hospital Wurzburg, Germany, and colleagues examined whether 24 months of treatment with the antidepressant escitalopram would ...

In LVSD, diabetes tied to higher risk of heart failure

April 20, 2018
(HealthDay)—In patients with asymptomatic left ventricular systolic dysfunction, diabetes is associated with an increased risk of developing heart failure, according to a study published online April 6 in Diabetes Care.

Depression raises risk of poor outcomes for blacks with heart failure

April 21, 2015
Among black heart failure patients, moderate depression may increase the risk of heart failure patients being hospitalized or dying, according to research in the American Heart Association journal Circulation: Heart Failure.

Study highlights need for better treatment of heart failure patients

March 27, 2018
A new study by researchers from the Universities of Leicester and Keele, has highlighted the need for better treatment of heart disease patients suffering from additional chronic conditions.

Anxiety, depression identify heart disease patients at increased risk of dying

March 19, 2013
Heart disease patients who have anxiety have twice the risk of dying from any cause compared to those without anxiety, according to new research in the Journal of the American Heart Association.

Recommended for you

Greening vacant lots reduces feelings of depression in city dwellers, study finds

July 20, 2018
Greening vacant urban land significantly reduces feelings of depression and improves overall mental health for the surrounding residents, researchers from the Perelman School of Medicine and the School of Arts & Sciences ...

People love to hate on do-gooders, especially at work

July 20, 2018
Sometimes, it doesn't pay to be a do-gooder, according to a new University of Guelph study.

New study questions use of talking therapy as a treatment for schizophrenia

July 20, 2018
The findings of the first meta-analysis examining the effectiveness of Cognitive Behavioural Therapy for psychosis (CBTp) on improving the quality of life and functioning and reducing distress of people diagnosed with schizophrenia ...

Perfectionism in young children may indicate OCD risk

July 19, 2018
Studying young children, researchers at Washington University School of Medicine in St. Louis found that kids who possess tendencies toward perfectionism and excessive self-control are twice as likely as other children to ...

Finding well-being through an aerial, as opposed to ground-level, view of time

July 19, 2018
Do today and yesterday and tomorrow loom large in your thinking, with the more distant past and future barely visible on the horizon? That's not unusual in today's time-pressed world—and it seems a recipe for angst.

Younger children tend to make more informed decisions

July 19, 2018
A new study from the University of Waterloo has found that in some ways, the older you get the worse your decision making becomes.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.