Ischemic heart disease (IHD) is a leading cause of morbidity and mortality in developed countries. Although advanced technology has increased the chances of survival and rehabilitation, less is known about the impact of anxiety and depression on the final outcome. The prevalence of heart failure (HF) is predicted to halve by 2030. This means that 8 million adults have heart failure and nearly $31 billion is needed to treat it.

New research focuses on this area to provide evidence for important recommendations in the treatment of such patients.

Mental health and heart disease outcomes

Several previous studies have reported that anxiety and depression are independent risk factors for IHD and HF. Anxiety increases her incidence of IHD and HF by 41% and 35%, respectively, and increases her IHD-related mortality by 41%. As anxiety and depression may be due to common factors, further research is needed on their interrelationships with cardiovascular disease and its outcomes.

Furthermore, both anxiety and depression increase the likelihood of hospital readmissions and emergency department (ED) visits, driving up healthcare costs. However, there is conflicting evidence about the benefits of treating anxiety and depression in IHD or HF, including recent trials such as SADHEART (Sertraline Antidepressant Heart Attack Randomized Trial).

However, these mental and physical conditions act synergistically with other conditions through common pathways, reducing quality of life. for example, “Co-occurrence of depression results in perceived severity of symptoms exceeding actual measures of functional impairment.”

About research

The objectives of the current study are published online. American Heart Association Journalaimed to examine the impact of treatment for anxiety or depression on repeat hospitalizations, emergency department visits, or mortality.

The researchers used a population-based cohort from the Ohio Medicaid database and retrospectively examined the data to assess the association between treatment of these conditions and future outcomes. All participants had ischemic heart disease (IHD) or heart failure, anxiety or depression.

There were approximately 1,500 participants, more than 80% Caucasian, and the average age was 50 years. The upper age limit is he is 64 years old, as anyone over this age is not eligible for Medicaid.

Treatment of anxiety and depression in a cohort

More than 92% were diagnosed with anxiety and 56% with depression. About half were disabled, an equal number had a history of drug use, and almost 60% had lung disease.

They were treated medically with antidepressants, psychotherapy, or both. About a quarter were receiving both treatments, about 30% were receiving antidepressants only, and 15% were receiving psychotherapy only.

90% of people receiving both treatments were diagnosed with anxiety and 70% with depression. In the antidepressant group, 93% felt anxious and 53% felt depressed. The corresponding figures for the psychotherapy group were similar.

The majority of people treated with antidepressants alone or in combination with psychotherapy were also taking benzodiazepines, antipsychotics, or mood stabilizers. Tricyclic antidepressants were used in a minority of patients.

About half of the patients were taking beta-blockers for heart disease, 36% were taking angiotensin-converting enzyme inhibitors (ACEIs), and 26% were taking calcium channel blockers.

How did the treatment affect the outcome?

For all outcomes except death due to IHD,People who received some form of mental health treatment were significantly less likely to experience its consequences than those who did not receive mental health treatment.”

Patients who received both psychotherapy and antidepressant therapy showed the greatest benefit on all three outcomes compared to no treatment and compared to either treatment alone. Ta.

The group treated with both treatments was 75% less likely to need another hospital stay or emergency room visit. After accounting for all known confounders, the risk of all-cause mortality was reduced by 65% ​​compared to people who did not receive treatment for mental illness.

Psychotherapy alone reduced all-cause mortality by 40%. There were no significant differences in the antidepressant-only group. None of the treatments made a difference in his risk of dying from IHD, likely because the study was underpowered.

All treatments reduced ED visits. The combination treatment group showed a 74% reduction compared to the no treatment group. Psychotherapy alone or antidepressants alone were associated with a 50% reduction in risk.

Readmission rates were also lower with the combination therapy, approximately 75% lower than in the no-treatment group. Psychotherapy alone or antidepressants alone reduced the risk by approximately 50% and 60%, respectively.

Future impact

“This article is the first to show that mental health treatment may be associated with a reduced risk of related outcomes”

This clear finding indicates the need to screen heart patients for anxiety and depression. When these conditions are diagnosed, providing appropriate treatment can significantly improve the risk of readmission and emergency department visits. Strategies for diagnosing and treating anxiety and depression must be optimized to improve the quality of life for this group of patients.

Sympathetic activation occurs during anxiety, depression, and heart disease. This results in the release of pro-inflammatory cytokines that promote the progression of all three conditions. This may partly explain why treatment of mental illness improves the incidence of cardiovascular events.

This represents an advance from previous studies that primarily focused on the safety of administering such drugs to patients with IHD or HF, and fills this research gap. Treating anxiety and depression in heart disease patients not only improves health outcomes, but is also cost-effective and can significantly reduce health care costs.