Depression, anxiety may worsen health of heart patients

WASHINGTON: Symptoms depression and anxiety are present in about one-third of heart failure patients, putting them at increased risk of progressive heart disease and other adverse outcomes, a study has found.

Yet depression and anxiety remain underrecognised and undertreated in patients with heart failure, said Christopher Celano, of Massachusetts General Hospital in the US.

"Diagnosing a psychiatric illness can be challenging in view of the significant overlap" between psychiatric symptoms and those related to heart failure, Celano said.

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," he said.

Heart failure is a chronic, progressive condition in which the heart can not pump enough blood, causing symptoms such as fatigue and shortness of breath. It causes death within five years in about 50 per cent of patients.

Previous studies have linked psychiatric disorders to worse outcomes in patients with heart failure. To clarify these relationships, researchers 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 per cent 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," Celano said.

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 per cent of patients have clinically significant anxiety symptoms, while 13 per cent meet diagnostic criteria for anxiety disorders (such as generalised 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.

Formal diagnostic interviews can help in assessing the cause of overlapping symptoms between heart failure and depression or anxiety for example, problems with sleep, concentration, or energy.


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