Mental illness (e.g., depression, anxiety) is common in patients with severe heart failure and should be taken seriously and treated. Overlapping symptoms of heart failure, as well as a depressive disorder, often make it difficult to identify psychological distress. Patients should be addressed for their mental health condition and professional psychological support should be offered or arranged if needed. It makes sense to include relatives in the treatment as well, since they can take on important tasks in the care and support of patients.
Psychocardiology is a new specialty that addresses the bidirectional relationships between psychosocial factors and cardiovascular disease. The specialty of psychocardiology thus covers the interface between the heart and the psyche and provides psychological-psychotherapeutic care for patients with cardiovascular disease. Psychological-psychotherapeutic support contributes to a better processing of the disease and to the promotion of health behavior. The term “psychocardiology” has become analogous to the term “psychooncology.”
Psychological problems in patients with heart failure
The multiple symptoms of heart failure lead to a significantly reduced quality of life for many patients. Compared with the normal population, patients with increasing NYHA class report limitations in various domains of quality of life (e.g., physiological functioning, as well as psychological and emotional well-being) [1]. Patients feel that their daily activities are severely restricted, for example, by the shortness of breath, and usually have to significantly reduce their range of movement and activity. Simple household activities can become an insurmountable hurdle for patients with severe heart failure. Cardiac decompensations lead to repeated hospitalizations, resulting in recurrent lifestyle interruptions for patients. In addition, there is the constant uncertainty regarding the course of this chronic disease as well as the fear of deterioration to the point of needing mechanical support (LVAD = Left Ventricular Assist Device) or a heart transplant.
The risk of developing depression is significantly higher in patients with heart failure than in patients without somatic disease [2,3]. According to ICD-10, the leading symptoms of a depressive disorder are depressed mood, lack of interest and pleasure, and a marked reduction in drive [9]. In addition, there are symptoms such as sleep disturbances, fatigue, loss of appetite, and decreased self-confidence/self-esteem. In the context of heart failure, it is often difficult to clearly distinguish depressive symptoms from symptoms of physical illness [3]. As a result, depressive disorders are often not recognized or are recognized too late and can in turn have a negative impact on the course of the disease. Patients who suffer from a depressive episode in addition to heart failure have a significantly worse prognosis than patients without depressive illness [4].
In addition to depressive disorders, patients with severe heart failure often suffer from various anxieties. These can range from real fear of disease progression to panic disorder triggered by respiratory distress [5]. Patients with an anxiety disorder tend to engage in avoidance and protective behavior, which in turn can have a negative impact on the course of the disease. Meaningful physical activities are accordingly avoided due to anxiety, which can lead to additional deconditioning.
Psychocardiology includes a psychological-psychotherapeutic service for patients with heart failure or other cardiovascular diseases. Patients are supported through psychological discussions in their processing of the disease and the development of new perspectives. Depressive disorders, anxiety or crises can thus be prevented and/or treated. Depending on the severity of the patient’s distress, the use of psychotropic drugs may be considered. In the treatment of depression, for example, patients benefit from identifying and changing negative thoughts, working out a daily structure, and fostering social contacts that enable a reduction in withdrawal behavior.
In addition to providing psychological support, psychocardiological discussions can also help improve adherence (e.g., limiting drinking, reducing salt intake). Patients with a depressive disorder in particular often have great difficulty implementing the recommended behavioral changes, which is why psychological support can also positively influence compliance.
Should a heart replacement procedure become necessary, psychological assessment of patients prior to heart transplantation or LVAD implantation represents important tasks in psychocardiology [6]. The aim of these assessment interviews is to identify psychological comorbidities and to gain as holistic an impression of the patient as possible. Psychosocial risk factors (e.g. substance abuse, dependence on noxious substances) as well as unfavorable coping strategies can be identified and treated if necessary. Special attention is also paid to the patient’s social environment, as this can contribute significantly to the patient’s overall situation and psychological stability [3].
If necessary, the psychocardiological service is also available to the patients’ relatives, as they are often also exposed to severe stress situations [7]. Relatives caring for an ill family member are themselves at increased risk of reduced quality of life, as well as increased risk of developing a mental disorder [8], so psychological support may be useful. Psychocardiological support can also help to relieve the burden on relatives in crisis situations.
Literature:
- Juenger J, et al: Health-related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Cardiovascular Medicine 2002; 87: 235-241.
- Faller H., et al.: Is health-related quality of life an independent predictor of survival in patients with chronic heart failure? Journal of Psychosomatic Research 2007; 63(5): 533-538.
- Herrmann-Lingen C, et al: Psychocardiology – A practical guide for physicians and psychologists. Cologne: Deutscher Ärzte Verlag, 2008.
- Rutledge T, et al: A Meta-Analytic Review of Prevalence, Intervention Effects, and Association with Clinical Outcomes. Journal of the American College of Cardiology 2006; 48(8): 1527-1537.
- Vongmany J, et al: Anxiety in chronic heart failure and the risk of increased hospitalisations and mortality: A systematic review. European Journal of Cardiovascular Nursing 2016 (Online: 24 Feb 2016). pii: 1474515116635923. [Epub ahead of print]
- Baba A, et al: Psychiatric problems of heart transplant candidates with left ventricular assist device. Journal of Artificial Organs 2006; 9(4): 203-208.
- Hwang B, et al: Caregiving for patients with heart failure: Impact on patients’ families. American Journal of Critical Care 2011; 20(6): 431-441.
- Hooley PJD, et al: The Relationship of Quality of Life, Depression, and Caregiver Burden in Outpatients With Congestive Heart Failure. Congestive Heart Failure 2005; 11(6): 303-310.
- Dilling H, et al: International classification of mental disorders: ICD-10 chapter V (F) – clinical diagnostic guidelines. Göttingen: Hogrefe, 2015.
CARDIOVASC 2016; 15(5): 30-32
HAUSARZT PRAXIS 2017; 12(1): 13-15
