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

College students choose smartphones over food

November 16, 2018
University at Buffalo researchers have found that college students prefer food deprivation over smartphone deprivation, according to results from a paper in Addictive Behaviors.

Social media is affecting the way we view our bodies—and not in a good way

November 15, 2018
Young women who actively engage with social media images of friends who they think are more attractive than themselves report feeling worse about their own appearance afterward, a York University study shows.

Study finds mindfulness apps can improve mental health

November 15, 2018
A University of Otago study has found that using mindfulness meditation applications (apps) on phones is associated with improvements in people's mental health.

New research has revealed we are actually better at remembering names than faces

November 14, 2018
With the Christmas party season fast approaching, there will be plenty of opportunity to re-live the familiar, and excruciatingly-awkward, social situation of not being able to remember an acquaintance's name.

Older adults' abstract reasoning ability predicts depressive symptoms over time

November 14, 2018
Age-related declines in abstract reasoning ability predict increasing depressive symptoms in subsequent years, according to data from a longitudinal study of older adults in Scotland. The research is published in Psychological ...

The illusion of multitasking boosts performance

November 13, 2018
Our ability to do things well suffers when we try to complete several tasks at once, but a series of experiments suggests that merely believing that we're multitasking may boost our performance by making us more engaged in ...

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.