Treating patients with CVD for anxiety, depression helps lower heart-related outcomes
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Key takeaways:
- In patients with heart disease and anxiety and/or depression, treatment for mental health improved clinical outcomes.
- The biggest improvement occurred in patients with both medical therapy and psychotherapy.
In patients with heart failure or coronary artery disease who also had anxiety and/or depression, treatment for their mental health condition was linked to better clinical outcomes, researchers reported.
“This may be the first study to show that treating anxiety and depression with medication or psychotherapy has a significant impact on heart disease outcomes,” Cheryl Carmin, PhD, a psychologist and director of behavioral cardiology services at The Ohio State University Wexner Medical Center and clinical professor of psychiatry and behavioral health at The Ohio State University College of Medicine, said in a press release from Ohio State.
Carmin and colleagues conducted a population-based retrospective cohort study of 1,563 patients (mean age, 50 years; 68% women) who had CAD or HF and comorbid anxiety and/or depression. Patients were stratified by whether they received both antidepressant medication and psychotherapy (23.2%), psychotherapy alone (14.8%), antidepressant medication alone (29.2%) or neither (33%). The findings were published in the Journal of the American Heart Association.
“Heart disease and anxiety/depression interact such that each promotes the other,” Philip Binkley, MD, MPH, executive vice chair of the department of internal medicine and emeritus professor of internal medicine and public health at The Ohio State University, said in a press release from the AHA. “There appear to be psychologic mechanisms that link heart disease with anxiety and depression that are currently under investigation. Both heart disease and anxiety/depression are associated with activation of the sympathetic nervous system. This is part of the so-called involuntary nervous system that increases heart rate, blood pressure and can also contribute to anxiety and depression.”
Compared with those receiving neither antidepressant medication nor psychotherapy, those receiving both had reduced risk for all-cause mortality (adjusted HR = 0.34; 95% CI, 0.21-0.55; P < .001), ED visits (aHR = 0.26; 95% CI, 0.2-0.34; P < .001) and hospital readmission (aHR = 0.25; 95% CI, 0.19-0.34; P < .001), and trended toward a reduction in CHD mortality (aHR = 0.32; 95% CI, 0.17-1.04; P = .06), according to the researchers.
Compared with those receiving neither antidepressant medication nor psychotherapy, those receiving psychotherapy alone had reduced risk for all-cause mortality (adjusted HR = 0.52; 95% CI, 0.37-0.75; P < .001), ED visits (aHR = 0.47; 95% CI, 0.37-0.59; P < .001) and hospital readmission (aHR = 0.51; 95% CI, 0.41-0.64; P < .001), and trended toward a reduction in CHD mortality (aHR = 0.42; 95% CI, 0.17-1.04; P = .06), the researchers wrote.
The antidepressants-alone group had lower risk for ED visits (aHR = 0.51; 95% CI, 0.42-0.62; P < .001) and hospital readmission (aHR = 0.42; 95% CI, 0.34-0.52; P < .001) compared with the group receiving neither antidepressant medication nor psychotherapy, but there were no differences in all-cause or CHD mortality risk, the researchers found.
“I hope the results of our study motivate cardiologists and health care professionals to screen routinely for depression and anxiety and demonstrate that collaborative care models are essential for the management of cardiovascular and mental health. I would also hope these findings inspire additional research regarding the mechanistic connections between mental health and heart disease,” Binkley said in the AHA press release.
References:
- Treating anxiety, depression in people with heart disease reduced ER visits, hospitalizations. https://newsroom.heart.org/news/treating-anxiety-depression-in-people-with-heart-disease-reduced-er-visits-hospitalizations. Published March 20, 2024. Accessed March 20, 2024.
- Treating anxiety, depression significantly impacts heart disease outcomes. https://wexnermedical.osu.edu/mediaroom/pressreleaselisting/treating-mental-health-helps-heart-disease. Published March 20, 2024. Accessed March 20, 2024.
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