Impact of Heart Failure on the Brain: A Mental Health Perspective
In the journey of living with heart failure, emotions can run high. It's common for individuals to experience a range of feelings such as fear, sadness, confusion, frustration, and anger. Taking the time to process these emotions, acknowledging them, expressing them, learning more about heart failure, and seeking support can help during this challenging time [1].
Post-traumatic stress disorder (PTSD) is another condition that may develop after a traumatic event, and symptoms include feeling alert or unable to relax, insomnia, nightmares, flashbacks (either emotional or visual), avoidance of triggers, and worsening of PTSD symptoms in people with heart failure [2]. If a person is experiencing thoughts of death or suicide, or they are self-harming, immediate help is needed. In the United States, this can be found by calling or texting the 988 Lifeline, texting HOME to the Crisis Text Line, or finding a helpline in your country with Befrienders Worldwide. In an emergency, call 911 or your local emergency services number [3].
Heart failure can potentially affect a person's mental health due to disruptions in future plans and self-perception [1]. Treatment guidelines recommend that doctors screen all people with heart failure for depression [4]. If a doctor does not, a person can bring this up at a follow-up appointment.
Depression and anxiety are common in people with heart failure, with rates higher than in the general population [6]. Depression and anxiety are treatable conditions, and if symptoms appear and do not get better with time, a person can seek support from their doctor or a therapist [7]. Joining a support group can help people with heart failure talk with others who have had similar experiences [8].
Self-care for people with heart failure may involve managing emotions and caring for physical needs as best as possible. This can include safely getting some exercise, remembering to drink water, eating regular meals, making time to connect with friends or family, getting enough sleep, celebrating small wins, and spending time in nature or with animals [9].
The relationship between heart failure and mental health significantly influences treatment options and patient outcomes because these conditions are deeply interconnected and can mutually worsen each other [10]. Managing both heart failure and mental health issues like depression or anxiety improves treatment effectiveness and reduces adverse events [2].
Cardiac rehabilitation that includes psychological support leads to better physical and mental health outcomes for heart failure patients [2]. Behavioral therapies such as cognitive behavioral therapy (CBT) can effectively reduce depression without worsening heart disease and are therefore valuable adjuncts in treatment plans [1].
The field of psychocardiology recognizes the heart-brain connection, emphasizing that chronic stress, anxiety, and trauma can exacerbate heart disease through increased inflammation and blood pressure. Conversely, heart disease can impair brain functions and lead to cognitive and mood disorders, necessitating collaborative care between cardiovascular and mental health specialists [5].
Treating heart failure without addressing mental health may lead to poorer adherence to medication and lifestyle changes, higher symptom burden, and increased hospital readmissions [1][2]. Conversely, addressing depression and anxiety can enhance quality of life and potentially reduce cardiovascular events [1][2].
In summary, optimal care for patients with heart failure requires a holistic approach that concurrently addresses mental health conditions. This integrated management leads to better cardiac function, reduced psychological distress, fewer complications, and improved overall prognosis. Multidisciplinary teams including cardiologists, psychologists, and rehabilitation specialists are essential to achieve these outcomes.
References: 1. Heart Failure Society of America (HFSA) 2021 Comprehensive Heart Failure Practice Guidelines 2. Cardiac rehabilitation for heart failure: a systematic review and meta-analysis of randomized controlled trials 3. National Institute of Mental Health (NIMH) Suicide Prevention Lifeline 4. Heart Failure Association of the European Society of Cardiology (HFA-ESC) 2016 guidelines for the diagnosis and treatment of acute and chronic heart failure 5. Psychocardiology: understanding the heart-brain connection 6. Depression and anxiety in heart failure: a systematic review and meta-analysis 7. Depression and heart failure: diagnosis and management 8. Heart failure support groups 9. Self-care for people with heart failure 10. Depression and heart failure: a bidirectional relationship
- Heart failure patients may experience depression and anxiety at higher rates than the general population, and these mental health issues can significantly impact treatment and patient outcomes.
- In the treatment of heart failure, it's essential to address both the physical and mental health aspects to improve adherence to medication and lifestyle changes, reduce psychological distress, and potentially lower cardiovascular events.
- Cardiac rehabilitation programs that include psychological support are beneficial for heart failure patients, leading to better physical and mental health outcomes.
- Behavioral therapies like cognitive behavioral therapy (CBT) can be effective in treating depression in heart failure patients, without worsening heart disease.
- Understanding the heart-brain connection is crucial in the field of psychocardiology, as chronic stress, anxiety, and trauma can worsen heart disease, while heart disease can lead to cognitive and mood disorders.
