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Anxiety, depression tied to adverse outcomes in patients with heart failure

A review of clinical research published in Harvard Review of Psychiatry found that depression and anxiety disorders remain underrecognized in patients with heart failure and may lead to adverse outcomes.

“Psychiatric illnesses are prevalent in patients with [heart failure], and prior work suggests that these disorders lead to negative health and cardiovascular outcomes in [heart failure] patients,” Christopher M. Celano, MD, from the department of psychiatry, Harvard Medical School and Massachusetts General Hospital, and colleagues wrote. “Depression and anxiety disorders — including generalized anxiety disorder, [PTSD] and panic disorder — are the most common psychiatric conditions in these patients.”

Although prior research has shown that anxiety and depressive disorders can adversely impact heart failure, patients with these disorders remain underdiagnosed and undertreated. The researchers conducted a targeted literature review to determine the links between depression, anxiety and heart failure. They also examined the mechanisms underlying the connections between these conditions and outcomes, possible methods for accurately diagnosing depression and anxiety disorders in patients with heart failure and reviewed the current clinical evidence for treatments of these conditions in this patient population.

Results from a meta-analysis of 36 studies showed that clinically significant depressive symptoms affect 21.5% of patients with heart failure. According to the researchers, one-third of patients with heart failure reported depressive symptoms on questionnaires and 19% met criteria for a depressive disorder recorded from diagnostic interviews. Prevalence of depressive symptoms and depressive disorder diagnosis in patients with heart failure were about two- to three-times higher than in the general population.

For anxiety, about 13% of patients with heart failure met diagnostic criteria for an anxiety disorder, usually generalized anxiety disorder, and almost 30% had clinically significant levels of anxiety reported on anxiety questionnaires. Depression and anxiety disorders were also linked to increased rates of mortality in patients with heart failure, the results showed.

Celano and colleagues found that adhering to formal diagnostic criteria and using clinical interview are vital to the evaluation process. Although they found limited evidence for the efficacy of pharmacologic and psychotherapy in patients with heart failure, prior research has shown that cognitive behavioral therapy may improve mental health outcomes in patients with heart failure and selective serotonin reuptake inhibitors appear safe in this population.

“Though diagnosing a psychiatric illness can be challenging in view of the significant overlap between psychiatric and [heart failure]-related symptoms, 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,” Celano and colleagues wrote. “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.” – by Savannah Demko

Disclosure: Celano reports honoraria for talks to Sunovion Pharmaceuticals.