Recognition and treatment of depression and anxiety symptoms in heart failure

Chronic illnesses, especially illnesses that severely affect functional abilities, such as heart failure (HF), are associated with significant physical, psychological, and lifestyle changes that often lead to increased mental health difficulties.1,2 The prevalence of depression and anxiety is far greater among chronically ill persons than among the general primary care population,3 with prevalence ranging from 30% to 50% in persons with HF.4–8 The impact of anxiety and depression is pervasive and can reduce patients’ ability to cope with physical symptoms and adhere to medical treatment.4,8,9 The combination of depression and/or anxiety with a chronic medical illness also leads to increased risk of mortality, worsening of quality of life, functional disability, and increased health care utilization and cost.3,5,10–13 Unfortunately, the rates for detecting and treating depression and anxiety among those with medical illnesses are quite low.14–17 Poor recognition and treatment of depression and anxiety may complicate and exacerbate HF symptoms, precipitate functional decline, disrupt social and occupational functioning, and lead to an increased risk of mortality.8,12,18–20 For Clinical Use ♦ Depression and anxiety are highly prevalent in heart failure patients. Unfortunately, a large percentage of heart failure patients with significant depression or anxiety symptoms go unrecognized and undertreated for mental health difficulties. ♦ Once recognized as having depression and/or anxiety, patients are more likely to receive mental health treatments. ♦ Clinicians are encouraged to routinely screen for depression and anxiety in patients with heart failure and other chronic illness. A host of barriers, including patient, provider, and systems factors, likely affect poor recognition and limited treatment for depression and anxiety, especially in medical care settings.21 As examples, barriers include negative patient expectations about mental health conditions and/or treatment, physician competing demands and/or limited mental health knowledge, and restricted availability of mental health resources.21–23 Although there is increasing information on the prevalence and impact of depression (and, to a lesser extent, anxiety) in the medically ill, few studies have examined rates of identified and treated mental health conditions, and no known studies have examined mental health recognition and treatment for outpatients with HF. The current study focused on ambulatory HF patients to (1) examine patient self-reported prevalence for depression and anxiety, (2) review electronic medical records (EMRs) to examine rates of system-level recognition and treatment of depression and anxiety over an 18-month extraction period, and (3) predict system-level recognition and treatment using patient demographic and clinical factors.