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Psychological Comorbidities in Heart Failure

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Heart Failure

Part of the book series: Cardiovascular Medicine ((CVM))

Abstract

Heart failure limits functional capacity and life expectancy, compromises quality of life and is associated with high healthcare costs. This is due not only to the physical symptoms of cardiac disease, but also to psychological comorbidities such as depression, anxiety and cognitive dysfunction. These comorbidities are much more common in patients with heart disease compared with the general population, and are associated with frequent decompensations and higher risk of hospitalization in heart failure. Demographic, biological, behaviour-related and psychosocial factors modulate the interaction between physical and mental disorders and should be considered in patient treatment. Screening tools can be easily applied to facilitate early detection. Multidisciplinary, individualized therapeutic approaches and physical activity improve patients’ well-being. In addition, active participation of patients in managing their somatic disease seems particularly important. To date, antidepressant pharmacotherapy has not shown any positive effects on mood and prognosis in patients with heart failure.

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References

  1. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006;48(8):1527–37.

    Article  PubMed  Google Scholar 

  2. Vaccarino V, Kasl SV, Abramson J, Krumholz HM. Depressive symptoms and risk of functional decline and death in patients with heart failure. J Am Coll Cardiol. 2001;38(1):199–205.

    Article  CAS  PubMed  Google Scholar 

  3. Konstam V, Moser DK, De Jong MJ. Depression and anxiety in heart failure. J Card Fail. 2005;11(6):455–63.

    Article  PubMed  Google Scholar 

  4. Angermann CE, Gelbrich G, Stork S, Schowalter M, Deckert J, Ertl G, et al. Somatic correlates of comorbid major depression in patients with systolic heart failure. Int J Cardiol. 2011;147(1):66–73.

    Article  PubMed  Google Scholar 

  5. Faller H, Stork S, Schowalter M, Steinbuchel T, Wollner V, Ertl G, et al. Depression and survival in chronic heart failure: does gender play a role? Eur J Heart Fail. 2007;9(10):1018–23.

    Article  PubMed  Google Scholar 

  6. Dekker RL, Lennie TA, Doering LV, Chung ML, Wu JR, Moser DK. Coexisting anxiety and depressive symptoms in patients with heart failure. Eur J Cardiovasc Nurs. 2014;13(2):168–76.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Suzuki T, Shiga T, Kuwahara K, Kobayashi S, Suzuki S, Nishimura K, et al. Impact of clustered depression and anxiety on mortality and rehospitalization in patients with heart failure. J Cardiol. 2014;64(6):456–62.

    Article  PubMed  Google Scholar 

  8. Chapa DW, Akintade B, Son H, Woltz P, Hunt D, Friedmann E, et al. Pathophysiological relationships between heart failure and depression and anxiety. Crit Care Nurse. 2014;34(2):14–24. quiz 5

    Article  PubMed  Google Scholar 

  9. Angermann CE, Kaspar M, Marx A, Kittel-Schneider S, Menhofer D, Stork S, et al. A functional variant of the neuropeptide S receptor-1 gene modulates clinical outcomes and healthcare utilization in patients with systolic heart failure: results from the Interdisciplinary Network Heart Failure (INH) Study. Eur J Heart Fail. 2017;19(3):314–23.

    Article  CAS  PubMed  Google Scholar 

  10. Alosco ML, Spitznagel MB, Raz N, Cohen R, Sweet LH, Colbert LH, et al. Obesity interacts with cerebral hypoperfusion to exacerbate cognitive impairment in older adults with heart failure. Cerebrovasc Dis Extra. 2012;2(1):88–98.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gure TR, Blaum CS, Giordani B, Koelling TM, Galecki A, Pressler SJ, et al. Prevalence of cognitive impairment in older adults with heart failure. J Am Geriatr Soc. 2012;60(9):1724–9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Almeida OP, Garrido GJ, Beer C, Lautenschlager NT, Arnolda L, Flicker L. Cognitive and brain changes associated with ischaemic heart disease and heart failure. Eur Heart J. 2012;33(14):1769–76.

    Article  PubMed  Google Scholar 

  13. McCaffery JM, Frasure-Smith N, Dube MP, Theroux P, Rouleau GA, Duan Q, et al. Common genetic vulnerability to depressive symptoms and coronary artery disease: a review and development of candidate genes related to inflammation and serotonin. Psychosom Med. 2006;68(2):187–200.

    Article  CAS  PubMed  Google Scholar 

  14. Domschke K, Reif A, Weber H, Richter J, Hohoff C, Ohrmann P, et al. Neuropeptide S receptor gene – converging evidence for a role in panic disorder. Mol Psychiatry. 2011;16(9):938–48.

    Article  CAS  PubMed  Google Scholar 

  15. Rozanski A, Blumenthal JA, Davidson KW, Saab PG, Kubzansky L. The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol. 2005;45(5):637–51.

    Article  PubMed  Google Scholar 

  16. Carney RM, Freedland KE, Veith RC. Depression, the autonomic nervous system, and coronary heart disease. Psychosom Med. 2005;67(Suppl 1):S29–33.

    Article  PubMed  Google Scholar 

  17. Kliks BR, Burgess MJ, Abildskov JA. Influence of sympathetic tone on ventricular fibrillation threshold during experimental coronary occlusion. Am J Cardiol. 1975;36(1):45–9.

    Article  CAS  PubMed  Google Scholar 

  18. Schwartz PJ. The autonomic nervous system and sudden death. Eur Heart J. 1998;19(Suppl F):F72–80.

    PubMed  Google Scholar 

  19. Yamaji M, Tsutamoto T, Kawahara C, Nishiyama K, Yamamoto T, Fujii M, et al. Serum cortisol as a useful predictor of cardiac events in patients with chronic heart failure: the impact of oxidative stress. Circ Heart Fail. 2009;2(6):608–15.

    Article  CAS  PubMed  Google Scholar 

  20. Grippo AJ, Johnson AK. Biological mechanisms in the relationship between depression and heart disease. Neurosci Biobehav Rev. 2002;26(8):941–62.

    Article  PubMed  Google Scholar 

  21. Kop WJ, Gottdiener JS. The role of immune system parameters in the relationship between depression and coronary artery disease. Psychosom Med. 2005;67(Suppl 1):S37–41.

    Article  PubMed  Google Scholar 

  22. Mahmoudi M, Curzen N, Gallagher PJ. Atherogenesis: the role of inflammation and infection. Histopathology. 2007;50(5):535–46.

    Article  CAS  PubMed  Google Scholar 

  23. Engelhardt S, Patkar S, Ogunshola OO. Cell-specific blood-brain barrier regulation in health and disease: a focus on hypoxia. Br J Pharmacol. 2014;171(5):1210–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Ampadu J, Morley JE. Heart failure and cognitive dysfunction. Int J Cardiol. 2015;178:12–23.

    Article  PubMed  Google Scholar 

  25. Fan H, Yu W, Zhang Q, Cao H, Li J, Wang J, et al. Depression after heart failure and risk of cardiovascular and all-cause mortality: a meta-analysis. Prev Med. 2014;63:36–42.

    Article  PubMed  Google Scholar 

  26. Bane C, Hughes CM, McElnay JC. The impact of depressive symptoms and psychosocial factors on medication adherence in cardiovascular disease. Patient Educ Couns. 2006;60(2):187–93.

    Article  PubMed  Google Scholar 

  27. Hare DL, Toukhsati SR, Johansson P, Jaarsma T. Depression and cardiovascular disease: a clinical review. Eur Heart J. 2014;35(21):1365–72.

    Article  PubMed  Google Scholar 

  28. World Health Organization. ICD-10 Classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.

    Google Scholar 

  29. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Arlington: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  30. Lowe B, Grafe K, Zipfel S, Witte S, Loerch B, Herzog W. Diagnosing ICD-10 depressive episodes: superior criterion validity of the Patient health questionnaire. Psychother Psychosom. 2004;73(6):386–90.

    Article  PubMed  Google Scholar 

  31. Spitzer RL, Williams JB, Gibbon M, First MB. The structured clinical interview for DSM-III-R (SCID). I: history, rationale, and description. Arch Gen Psychiatry. 1992;49(8):624–9.

    Article  CAS  PubMed  Google Scholar 

  32. Lowe B, Kroenke K, Grafe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res. 2005;58(2):163–71.

    Article  PubMed  Google Scholar 

  33. Piepenburg SM, Faller H, Gelbrich G, Stork S, Warrings B, Ertl G, et al. Comparative potential of the 2-item versus the 9-item patient health questionnaire to predict death or rehospitalization in heart failure. Circ Heart Fail. 2015;8(3):464–72.

    Article  PubMed  Google Scholar 

  34. Lichtman JH, Bigger JT Jr, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lesperance F, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association prevention committee of the council on cardiovascular nursing, council on clinical cardiology, council on epidemiology and prevention, and interdisciplinary council on quality of care and outcomes research: endorsed by the American Psychiatric Association. Circulation. 2008;118(17):1768–75.

    Article  PubMed  Google Scholar 

  35. Kroenke K, Spitzer RL, Williams JB. The patient health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–92.

    Article  PubMed  Google Scholar 

  36. Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.

    Article  PubMed  Google Scholar 

  37. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25.

    Article  PubMed  Google Scholar 

  38. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.

    Article  CAS  PubMed  Google Scholar 

  39. Dodson JA, Chaudhry SI. Geriatric conditions in heart failure. Curr Cardiovasc Risk Rep. 2012;6(5):404–10.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Harkness K, Demers C, Heckman GA, McKelvie RS. Screening for cognitive deficits using the Montreal cognitive assessment tool in outpatients >/=65 years of age with heart failure. Am J Cardiol. 2011;107(8):1203–7.

    Article  PubMed  Google Scholar 

  41. Jiang W, Alexander J, Christopher E, Kuchibhatla M, Gaulden LH, Cuffe MS, et al. Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med. 2001;161(15):1849–56.

    Article  CAS  PubMed  Google Scholar 

  42. Jiang W, Krishnan R, Kuchibhatla M, Cuffe MS, Martsberger C, Arias RM, et al. Characteristics of depression remission and its relation with cardiovascular outcome among patients with chronic heart failure (from the SADHART-CHF Study). Am J Cardiol. 2011;107(4):545–51.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Moraska AR, Chamberlain AM, Shah ND, Vickers KS, Rummans TA, Dunlay SM, et al. Depression, healthcare utilization, and death in heart failure: A community study. Circ Heart Fail. 2013;6(3):387.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Sayers SL, Hanrahan N, Kutney A, Clarke SP, Reis BF, Riegel B. Psychiatric comorbidity and greater hospitalization risk, longer length of stay, and higher hospitalization costs in older adults with heart failure. J Am Geriatr Soc. 2007;55(10):1585–91.

    Article  PubMed  Google Scholar 

  45. Wulsin LR, Singal BM. Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosom Med. 2003;65(2):201–10.

    Article  PubMed  Google Scholar 

  46. De Jong MJ, Chung ML, Wu JR, Riegel B, Rayens MK, Moser DK. Linkages between anxiety and outcomes in heart failure. Heart Lung. 2011;40(5):393–404.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891–975.

    Article  PubMed  Google Scholar 

  48. Cohen HW, Gibson G, Alderman MH. Excess risk of myocardial infarction in patients treated with antidepressant medications: association with use of tricyclic agents. Am J Med. 2000;108(1):2–8.

    Article  CAS  PubMed  Google Scholar 

  49. Piepenburg SM, Ertl G, Angermann CE. Depression und Herzinsuffizienz – eine gefährliche Kombination. Dtsch Med Wochenschr. 2016;141(17):1222–7. (im Druck)

    Article  PubMed  Google Scholar 

  50. Wallenborn J, Angermann CE. Comorbid depression in heart failure. Herz. 2013;38(6):587–96.

    Article  CAS  PubMed  Google Scholar 

  51. Woltz PC, Chapa DW, Friedmann E, Son H, Akintade B, Thomas SA. Effects of interventions on depression in heart failure: a systematic review. Heart Lung. 2012;41(5):469–83.

    Article  PubMed  Google Scholar 

  52. Glassman AH, O’Connor CM, Califf RM, Swedberg K, Schwartz P, Bigger JT Jr, et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA. 2002;288(6):701–9.

    Article  CAS  PubMed  Google Scholar 

  53. Berkman LF, Blumenthal J, Burg M, Carney RM, Catellier D, Cowan MJ, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) randomized trial. JAMA. 2003;289(23):3106–16.

    Article  PubMed  Google Scholar 

  54. Lesperance F, Frasure-Smith N, Koszycki D, Laliberte MA, van Zyl LT, Baker B, et al. Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. JAMA. 2007;297(4):367–79.

    Article  CAS  PubMed  Google Scholar 

  55. van den Brink RH, van Melle JP, Honig A, Schene AH, Crijns HJ, Lambert FP, et al. Treatment of depression after myocardial infarction and the effects on cardiac prognosis and quality of life: rationale and outline of the Myocardial INfarction and Depression-Intervention Trial (MIND-IT). Am Heart J. 2002;144(2):219–25.

    Article  PubMed  Google Scholar 

  56. O’Connor CM, Jiang W, Kuchibhatla M, Silva SG, Cuffe MS, Callwood DD, et al. Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial. J Am Coll Cardiol. 2010;56(9):692–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  57. Angermann CE, Gelbrich G, Stork S, Gunold H, Edelmann F, Wachter R, et al. Effect of Escitalopram on all-cause mortality and hospitalization in patients with heart failure and depression: The MOOD-HF randomized clinical trial. JAMA. 2016;315(24):2683–93.

    Article  CAS  PubMed  Google Scholar 

  58. Freedland KE, Carney RM, Rich MW, Steinmeyer BC, Rubin EH. Cognitive behavior therapy for depression and self-care in heart failure patients: a randomized clinical trial. JAMA Intern Med. 2015;175(11):1773–82.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Huffman JC, Mastromauro CA, Beach SR, Celano CM, Dubois CM, Healy BC, et al. Collaborative care for depression and anxiety disorders in patients with recent cardiac events: the Management of Sadness and Anxiety in Cardiology (MOSAIC) randomized clinical trial. JAMA Intern Med. 2014;174(6):927–35.

    Article  CAS  PubMed  Google Scholar 

  60. Blumenthal JA, Babyak MA, O’Connor C, Keteyian S, Landzberg J, Howlett J, et al. Effects of exercise training on depressive symptoms in patients with chronic heart failure: the HF-ACTION randomized trial. JAMA. 2012;308(5):465–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Tu RH, Zeng ZY, Zhong GQ, Wu WF, Lu YJ, Bo ZD, et al. Effects of exercise training on depression in patients with heart failure: a systematic review and meta-analysis of randomized controlled trials. Eur J Heart Fail. 2014;16(7):749–57.

    Article  PubMed  Google Scholar 

  62. Jiang W, Oken H, Fiuzat M, Shaw LK, Martsberger C, Kuchibhatla M, et al. Plasma omega-3 polyunsaturated fatty acids and survival in patients with chronic heart failure and major depressive disorder. J Cardiovasc Transl Res. 2012;5(1):92–9.

    Article  PubMed  Google Scholar 

  63. Appleton KM, Rogers PJ, Ness AR. Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. Am J Clin Nutr. 2010;91(3):757–70.

    Article  CAS  PubMed  Google Scholar 

  64. Tavazzi L, Maggioni AP, Marchioli R, Barlera S, Franzosi MG, Latini R, et al. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet. 2008;372(9645):1223–30.

    Article  PubMed  CAS  Google Scholar 

  65. Hedayati SS, Gregg LP, Carmody T, Jain N, Toups M, Rush AJ, et al. Effect of sertraline on depressive symptoms in patients with chronic kidney disease without dialysis dependence: the CAST randomized clinical trial. JAMA. 2017;318(19):1876–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Walther CP, Shah AA, Winkelmayer WC. Treating depression in patients with advanced CKD: beyond the generalizability frontier. JAMA. 2017;318(19):1873–4.

    Article  PubMed  Google Scholar 

  67. Gary RA, Dunbar SB, Higgins MK, Musselman DL, Smith AL. Combined exercise and cognitive behavioral therapy improves outcomes in patients with heart failure. J Psychosom Res. 2010;69(2):119–31.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Groot C, Hooghiemstra AM, Raijmakers PG, van Berckel BN, Scheltens P, Scherder EJ, et al. The effect of physical activity on cognitive function in patients with dementia: A meta-analysis of randomized control trials. Ageing Res Rev. 2016;25:13–23.

    Article  CAS  PubMed  Google Scholar 

  69. Smith PJ, Blumenthal JA, Hoffman BM, Cooper H, Strauman TA, Welsh-Bohmer K, et al. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med. 2010;72(3):239–52.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Zheng G, Xia R, Zhou W, Tao J, Chen L. Aerobic exercise ameliorates cognitive function in older adults with mild cognitive impairment: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2016;50(23):1443–50.

    Article  PubMed  Google Scholar 

  71. Wenger NK. Current status of cardiac rehabilitation. J Am Coll Cardiol. 2008;51(17):1619–31.

    Article  PubMed  Google Scholar 

  72. Perez-Lopez FR, Martinez-Dominguez SJ, Lajusticia H, Chedraui P. Health outcomes systematic analyses P. Effects of programmed exercise on depressive symptoms in midlife and older women: A meta-analysis of randomized controlled trials. Maturitas. 2017;106:38–47.

    Article  PubMed  Google Scholar 

  73. Angermann CE, Stork S, Gelbrich G, Faller H, Jahns R, Frantz S, et al. Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure: the Interdisciplinary Network for Heart Failure (INH) study. Circ Heart Fail. 2012;5(1):25–35.

    Article  PubMed  Google Scholar 

  74. Jaarsma T, van der Wal MH, Lesman-Leegte I, Luttik ML, Hogenhuis J, Veeger NJ, et al. Effect of moderate or intensive disease management program on outcome in patients with heart failure: Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH). Arch Intern Med. 2008;168(3):316–24.

    Article  PubMed  Google Scholar 

  75. Gunold H, Angermann CE. Kognitive Dysfunktion, Depression und Angst bei Herzinsuffizienz. Aktuel Kardol. 2015;4:379–86.

    Article  Google Scholar 

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Angermann, C.E., Wallenborn, J. (2019). Psychological Comorbidities in Heart Failure. In: Feldman, D., Mohacsi, P. (eds) Heart Failure. Cardiovascular Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-98184-0_13

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