An observational analysis of the Ohio Medicaid database showed that mental health treatment was strongly associated with improved clinical outcomes in people with heart disease and comorbid anxiety and depression.

Patients hospitalized with coronary artery disease (CAD) or heart failure (HF) and who had a record of psychotherapy and antidepressant use had lower rates of subsequent There tended to be fewer events.

• All-cause mortality: HR 0.33 (95% CI 0.23-0.46)
• Mortality from coronary heart disease: HR 0.47 (95% CI 0.21-1.02)
• Emergency department (ED) visit: HR 0.32 (95% CI 0.26-0.39)
• Readmission: HR 0.30 (95% CI 0.24-0.38)

Philip Binkley, MD, MPH, of The Ohio State University Wexner Medical Center in Columbus, and colleagues found that the results were similar even after adjusting for comorbidities, drug use, and prior diagnoses of depression or substance use disorders. reported. American Heart Association Journal.

Psychotherapy or antidepressants alone were also associated with improved clinical outcomes. Depending on the specific endpoint analyzed in the population-based cohort study, the hazard ratio for each treatment ranged from 0.48 to 0.70.

“To the authors’ knowledge, this paper is the first to show that mental health treatment may be associated with a reduced risk of a related outcome,” Binkley’s group concluded. “These findings demonstrate that mental health interventions are essential to reduce hospitalizations and emergency department visits for patients with heart failure, coronary artery disease, and associated depression and anxiety disorders. ”

“The findings related to CAD-related mortality are suggestive but not significant. This is due to the relatively small sample size of patients with this diagnosis and the consequent insufficient statistics to detect an effect.” “This may be related to the lack of statistical power,” the authors said. .

Previous studies have shown that depressive symptoms are associated with increased risk of all-cause and cardiovascular mortality based on the National Health and Nutrition Examination Survey. Additionally, population studies in the United Kingdom and Finland found that people with severe or moderate depression were at increased risk for a variety of physical illnesses requiring hospitalization, such as ischemic heart disease and diabetes.

Binkley’s team acknowledged that the evidence for a link between anxiety and heart disease was not as strong, but argued that there was evidence for a general heart-brain link.

“Both heart disease and anxiety are associated with activation of the sympathetic nervous system and the production and release of pro-inflammatory cytokines. When these systems are activated simultaneously, central nervous system interventions such as anxiety and depression can occur. “This accelerates the progression of both heart disease and heart disease,” the group explained.

“Heart disease and anxiety/depression interact, and each promotes the other,” Binkley said in a press release. “There appears to be a mental process that links heart disease to anxiety and depression, and we are currently investigating it.”

Meanwhile, Binkley said she hopes the findings will encourage cardiologists and other medical professionals to regularly screen for depression and anxiety.

“Effective strategies for identifying anxiety and depression in patients and subsequently providing effective treatment could be important strategies that allow clinicians to improve the quality of life of patients with heart failure.” his group writes.

In addition to medication and psychotherapy, some patients are turning to transcranial magnetic stimulation (TMS) to treat depression and other neuropsychiatric disorders. Laboratory experiments suggest that the risk of cardiac implant damage or overheating during TMS is low.

The American Heart Association predicts that heart disease has continued to rise over the past decade, reaching 43.9% of Americans by 2030, and the cost of heart failure alone will total nearly $70 billion.

“Interventions that can reduce the frequency of readmissions and ED treatment have the potential to significantly reduce health care costs, considering the costs of hospital and ED visits and mental health professional visits. Our results suggest that the cost-effectiveness ratio for mental health care is likely to be significant,” Binkley’s group wrote.

For the study, the authors collected data from Ohio Medicaid claims files and death certificates from 2009 to 2012. Patients with anxiety or depression who were hospitalized for CAD or HF were followed up to the end of 2014 for up to four years.

The subjects were 1,563 people (average age 50 years, 68% female). Four of the five were white. 92.2% were diagnosed with anxiety and 55.5% with depression. More than 53% were also diagnosed with substance abuse.

Based on pharmacy records and billing codes, researchers found that 23.2% of participants received antidepressants and psychotherapy, 14.8% received psychotherapy only, 29.2% received antidepressants only, and 33% received psychotherapy. It was assumed that the patient did not receive health treatment.

The study authors noted that Medicaid only covers people between the ages of 21 and 64, and acknowledged that the study may not be generalizable to the broader population or older adults.

“A collaborative care model is essential to managing cardiovascular and mental health,” Binkley asserted. “We hope these findings will spark further research into the mechanistic links between mental health and heart disease.”