Ischemic heart disease (IHD) is a major cause of illness and death in developed countries. While advanced technology has boosted survival and rehabilitation odds, not much is known about the impact of anxiety or depression on the eventual outcomes. The prevalence of heart failure (HF) is predicted to increase by half in 2030. This will mean that eight million adults with HF, with almost $31 billion being required to treat them.
A new study looks at this area in order to provide evidence for key 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 the incidence of IHD and HF by 41% and 35%, respectively, while increasing IHD-related mortality by 41%. Since anxiety and depression may originate in common factors, further research on their cross-linkage with cardiovascular disease and its outcomes is necessary.
Moreover, anxiety and depression both increase the odds of rehospitalizations and Emergency Department (ED) visits, pushing up healthcare costs. However, there is contradictory evidence for the benefits of treating anxiety or depression in IHD or HF, including recent trials like the SADHEART (Sertraline Antidepressant Heart Attack Randomized Trial).
Yet these mental and physical conditions reduce the quality of life, acting synergistically with the others due to their shared pathways. For instance, “coexistence of depression results in perception of symptom severity that exceed measures of actual functional impairment.”
About the study
The aim of the current study, published online in the Journal of the American Heart Association, aimed to examine the effect of treatment for anxiety or depression on the odds of repeated hospital admissions, ED visits, or mortality.
The researchers used a population-based cohort from the Ohio Medicaid database, exploring data retrospectively to assess the link between being treated for these conditions and future outcomes. All participants had ischemic heart disease (IHD) or heart failure, along with anxiety or depression.
There were ~1,500 participants, over 80% being White, with a mean age of 50 years. The upper age limit was 64 since people older than this are not eligible for Medicaid.
Treatment of anxiety and depression in the cohort
Over 92% were diagnosed with anxiety and 56% with depression. About half were disabled, a similar number had a history of substance use, and almost 60% had lung disease.
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They were treated medically with antidepressant medication, or with psychotherapy, or both. About a quarter were on both courses of treatment, while ~30% were on antidepressants only and 15% on psychotherapy alone.
Anxiety was diagnosed in 90% of those on both therapies and depression in 70%. In the antidepressant group, 93% were anxious, and 53% were depressed. The corresponding figures in the psychotherapy group were similar.
The majority of those on treatment with antidepressants, alone or in combination with psychotherapy, were on benzodiazepines, antipsychotics, or mood stabilizers. Tricyclic antidepressants were used by a small proportion of patients.
About half the patients were on beta-blockers for their heart conditions, 36% on angiotensin-converting enzyme inhibitors (ACEIs), and 26% on calcium channel blockers.
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