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Patients with heart failure who are suffering from depression and anxiety are at greater risk for progressive heart disease and other adverse outcomes, according to a new study published in Harvard Review of Psychiatry . In addition, healthy people with depression are more likely to develop heart failure.
Heart failure is a chronic, progressive disease in which the heart can not pump enough blood, causing symptoms such as fatigue and shortness of breath. This disease affects more than five million Americans and leads to death in about five years in about 50% of patients.
Although symptoms of depression and anxiety are present in about one-third of patients with heart failure, these mental disorders remain unrecognized. "The diagnosis of a psychiatric illness can be difficult given the significant overlap" between psychiatric symptoms and those related to heart failure, said Christopher Celano, MD, Mbadachusetts General Hospital. Nevertheless, "doing the effort can help identify those who are at higher risk for poor cardiac outcomes and to implement treatment for these disorders."
Previous studies have linked psychiatric disorders to worse outcomes in heart failure patients. To clarify these badociations, Celano and his colleagues conducted a focused review of research on the links between heart failure, depression, and anxiety.
Their results confirm "significantly higher" rates of depression and anxiety disorders in patients with heart failure. the general population. Research has shown that one-third of patients with heart failure reported high symptoms of depression on standard questionnaires, while 19 percent fulfilled the diagnostic criteria for major depression or other depressive disorders.
"Depression is linked to the development and progression of heart failure and other cardiovascular diseases," the researchers write. Studies suggest not only that patients with heart failure with depression present an increased risk of death or cardiac events, but also that depressed adults are more likely to develop heart failure.
Prevalence of anxiety is also high in heart failure Nearly 30% of patients have clinically significant anxiety symptoms, while 13% meet criteria for diagnosis of anxiety disorders (such as generalized anxiety disorder, post-traumatic stress disorder or panic disorder). Some studies have badociated anxiety with adverse heart failure outcomes, although the evidence is less consistent than for depression.
Physiological and behavioral factors may contribute to poorer results. Depression and anxiety can make it more difficult for patients with heart failure to follow the recommendations for diet, exercise and the use of medications. Studies have also linked depression to metabolic changes, including higher levels of inflammatory markers.
Researchers believe that formal diagnostic interviews can help to badess the cause of symptoms of overlap between heart failure and depression or anxiety. or energy.
For the treatment of depression and anxiety in patients with heart failure, psychotherapy may present advantages over drugs. In fact, cognitive-behavioral therapy is the only type of psychotherapy specifically effective in heart failure patients.
Despite the lack of specific evidence of their efficacy in patients with heart failure, antidepressants such as selective serotonin reuptake inhibitors recommended, with close monitoring, given their known beneficial effects in the treatment depression and anxiety in other populations.
The researchers point to the need for further research on effective treatments for the large group of patients with heart failure complicated with depression and anxiety. 19659002] Source: Wolters Kluwer Health
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