Mental health in chronic and end-stage heart disease

Abstract

Patients with heart disease and heart failure (HF) have increased rates of depression and anxiety. Not only these psychiatric conditions cause significant distress and impaired quality of life, but research has shown that depression increases the risk of hospitalizations, worsens adherence to medication regimen, and increases the mortality in cardiac transplant recipients. While studies on pharmacological treatments for depression have been promising in patients with ischemic heart disease, so far antidepressants have not been demonstrated as effective treatments for depression in patients with HF. In addition, treatment of depression with antidepressants has not been shown to decrease mortality in cardiac patients; however, remission of depression in general has been shown to be associated with such decrease. Non-pharmacological treatments, such as therapy, exercise, and collaborative care modes are promising for better identification and reduction of mental disorder symptoms. In addition, patients with severe mental illness are at higher risk for cardiovascular mortality and are less likely to receive needed treatments. Finally, cognitive impairment is common in cardiac patients and contributes to challenges in care.