Germany: Anxiety and Depression in Heart Failure Patients

Anxiety and depression are more common in patients with heart failure (HF) than those with cancer, finds a recent study in the European Journal of Preventive Cardiology.

According to the study, 23.1% of HF patients were diagnosed with depression compared to:

• 25.7% of breast cancer patients
• 22.1% of patients with cancer of the digestive organs
• 15.0% of patients with prostate cancer

"The treatment of mental illnesses in cancer patients - psycho-oncology - is long-established but similar services for heart patients (psycho-cardiology) are still in their infancy," said study author Dr. Mark Luedde of the Cardiological Group Practice, Bremerhaven, Germany. "Our study suggests that heart failure patients could benefit from greater support with psychological problems."

Heart failure affects around 65 million people worldwide and is more deadly than some cancers. The number of co-existing conditions in heart failure patients is also rising, and they are connected with poorer quality of life.

Mark Luedde and colleagues aimed to compare the incidence of depression over the course of HF and over that of the most common cancers (breast, prostate, digestive) in a large cohort of outpatients in Germany.

The study used information from the nationally representative German Disease Analyzer database, which includes approximately 3% of outpatient practices. The researchers compared the combined incidence of depression and anxiety during the five years after a diagnosis of heart failure or cancer.

The retrospective analysis included adults with an initial diagnosis of heart failure, breast cancer, prostate cancer, or digestive organ cancer in 1,274 general practices between 2000 and 2018. This was a total of:

• 96,772 patients with heart failure
• 21,261 patients with breast cancer
• 16,478 patients with prostate cancer
• 29,479 patients with cancer of the digestive organs

Within five years after diagnosis, 23.1% of heart failure patients had developed depression or anxiety compared to 25.7%, 22.1%, and 15.0% of patients with breast, digestive, and prostate cancers, respectively.

When compared to overall cancer, heart failure patients had a significantly higher risk of developing depression or anxiety with a hazard ratio of 1.20 (95% confidence interval 1.18-1.23; p<0.001). More specifically, the risk of depression or anxiety for heart failure patients was 66% higher than those with prostate cancer and 17% higher than those with gastrointestinal cancer. Risks of depression and anxiety were similar between heart failure patients and those with breast cancer.

In all four groups, the incidence of depression and anxiety increased continually over the five years of follow-up.

Dr. Luedde said: "The high incidence of depression and anxiety in heart failure patients shows the importance of these problems. While we did not investigate the causes of mental health issues, the even higher occurrence in those with breast cancer may be connected to a fear of recurrence. The rising incidence of psychological problems over time in both heart failure and cancer could be due to limitations on daily activities caused by fatigue, impaired mobility, and other debilitating symptoms."

Dr. Luedde concluded: "Psychological support services for patients with cancer are relatively common. However, more help is needed for those with heart failure - of whom almost one-quarter develop depression or anxiety after their diagnosis."

Reference

The study titled, "Heart failure and depression: a comparative analysis with different types of cancer," is published in the European Journal of Preventive Cardiology.

DOI: https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwab048/6211646