Philip Binkley, MD, MPH

Credit: The Ohio State University, Wexner Medical Center

Treating anxiety and depression not only improves a person’s well-being, it can also save lives, at least for people with heart disease.¹ A new study found that heart patients treated for anxiety and depression had significantly fewer emergency room visits and hospital readmissions.

“For patients admitted with coronary artery disease or heart failure and diagnosed with anxiety or depression, treatment with psychotherapy, pharmacotherapy, or a combination of both can reduce the number of hospitalizations or emergency room visits by as much as 75%. ,” said lead researcher Philip Binkley, MD, MPH, associate chair of internal medicine and professor emeritus of internal medicine and public health at The Ohio State University, in a press release.² “In some cases, the number of deaths has decreased.”

People with heart failure often experience anxiety and depression.¹ Mental health can increase an individual’s risk for other health conditions, disability, and death.

Researchers aimed to assess the association between mental health treatment with antidepressants, psychotherapy, or a combination of the two, and emergency department visits, hospital readmissions, all-cause mortality, and mortality from heart disease. A population-based retrospective cohort design was performed. People with coronary artery disease or heart failure. Participants had a formal diagnosis of anxiety or depression before admission.

“Heart disease and anxiety/depression interact, and each promotes the other,” Binkley says.² “It seems there is [psychological] The mechanisms linking heart disease to anxiety and depression are currently under investigation. Both heart disease and anxiety/depression are associated with activation of the sympathetic nervous system. This is part of the so-called involuntary nervous system, which increases heart rate and blood pressure and can also contribute to anxiety and depression. ”

The study included 1,563 adults aged 22 to 64 years (mean age: 50.1 years) enrolled over a three-year period.^.1 Participants had been hospitalized for arterial blockage or heart failure and had two or more health insurance claims for anxiety or depression. A total of 68% of participants were female and 80.9% reported being Caucasian.

All participants were enrolled in Ohio’s Medicaid program for 6 months prior to hospitalization. The team utilized data from the Ohio Medicaid claims and Ohio death certificate files from July 1, 2009 to June 30, 2012. They followed participants until the end of 2014, death, or termination of Medicaid enrollment.

Before admission, approximately 92% of participants were diagnosed with anxiety and 55.5% with depression. About 23% of participants received both antidepressants and psychotherapy, nearly 15% received psychotherapy only, 29% received antidepressants only, and 33% received no mental health treatment.

The combination of antidepressants and psychotherapy for anxiety and depression reduced the risk of hospitalization (68% to 75%), emergency department visit (67% to 74%), and death (67%). The three models showed that all treatments were associated with a significant reduction in the risk of emergency department visit (P < .001). Regarding readmissions, all treatments in the three models significantly reduced the risk (P < .001).

Receiving psychotherapy alone reduced the risk of readmission (46% to 49%) and emergency department visit (48% to 53%). Hospitals that provided medication-only treatment experienced a 58% reduction in readmissions and a 49% reduction in emergency department visits.

The researchers noted that because the study was limited to people with Medicaid, the findings may not be representative of people with other insurance plans. Furthermore, because most of the sample was Caucasian, the results may not apply to other races and ethnicities.

“Our findings motivate cardiologists and health care professionals to regularly screen for depression and anxiety, and demonstrate that collaborative care models are essential for managing cardiovascular and mental health. I hope that,” Binkley said.² “We also hope that these findings will spur further research into the mechanistic links between mental health and heart disease.”

^References

1. ^{Karmin CN, Ownby RL, Fontanella C, Steelsmith D, Binkley PF. The impact of mental health treatment on outcomes in patients with heart failure and ischemic heart disease. J. Am Heart Assoc. Published online March 20, 2024. doi:10.1161/JAHA.123.031117}
2. ^{Treating anxiety and depression in heart patients reduces ER visits and hospitalizations. Yurek Alert! March 20, 2024. https://www.eurekalert.org/news-releases/1038357. Accessed March 22, 2024.}