Depression in pulmonary arterial hypertension: An undertreated comorbidity

Objectives: To identify patterns of exercise behaviour, attitudes towards exercise, barriers and enablers of exercise for people living with Pulmonary Hypertension (PH). Accessibility of rehabilitation services from a patient perspective was also explored. Methods: a voluntary, international survey of people living with PH was conducted, with mixed quantitative and qualitative data collection, in an online and paper format. Results: Data from 187 participants in 19 countries were included in the analyses. 52% (95/183) of people with PH reported that they attempted to engage in regular physical activity. This was less than the proportion who did so prior to diagnosis (61%, 112/184, p=0.006), and was accompanied by uncertainty and anxiety about exercise. 63% (113/180) of the cohort reported experiencing previous adverse events whilst exercising, which was associated with a greater likelihood of ongoing exercise concerns and anxiety. Fear, frustration and uncertainty about exercise were noted as common barriers to engaging in exercise with PH. Other barriers to exercise included intrinsic factors such as debilitating breathlessness and fatigue, and external factors such as cost and access to appropriate services. Most respondents (76%, 128/169) did not have access to a multi-disciplinary rehabilitation service, although an overwhelming majority (92%, 159/172) reported this would be helpful. Respondents rated education; a supervised, structured exercise program; and psychology input as the most important components of a multi-disciplinary rehabilitation service for PH. Conclusion: Health professionals must work together with consumers to co-design rehabilitation services that will facilitate exercise and increased activity for people living with PH.

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“…Psychotherapy, psychotropic medications, and/or progressive muscle relaxation techniques may be useful in this context. 29…”

Section: Enablers Of Exercisementioning

confidence: 99%

‘Tired, afraid, breathless … .’ An international survey of the exercise experience for people living with pulmonary hypertension

et al. 2020

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“…Despite the prevalence of depression in patients with PAH, optimal pharmacological approaches are not well defined 55 . In the general population, psychotherapy is recommended in mild depression, with the addition of pharmacological therapies for moderate-to-severe depression.…”

Section: Management Considerations With Comorbidities and Pulmonary Amentioning

confidence: 99%

“…Selective serotonin reuptake inhibitors (SSRIs) have been associated with higher risk of mortality and clinical worsening in patients with PAH, compared with patients not taking SSRIs 56 . Patients with PAH may also consider joining patient support groups to help them cope with the uncertainty associated with the disease 55 , 57 …”

Section: Management Considerations With Comorbidities and Pulmonary Amentioning

confidence: 99%

The burden of comorbidities in pulmonary arterial hypertension

Lang

Palazzini

2019

European Heart Journal Supplements

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Patients with comorbidities are often excluded from clinical trials, limiting the evidence base for pulmonary arterial hypertension (PAH)-specific therapies. This review aims to discuss the effect of comorbidities on the diagnosis and management of PAH. The comorbidities discussed in this review (systemic hypertension, obesity, sleep apnoea, clinical depression, obstructive airway disease, thyroid disease, diabetes, and ischaemic cardiovascular event) were chosen based on their prevalence in patients with idiopathic PAH in the REVEAL registry (Registry to EValuate Early and Long-term PAH disease management). Comorbidities can mask the symptoms of PAH, leading to delays in diagnosis and also difficulty evaluating disease progression and treatment effects. Due to the multifactorial pathophysiology of pulmonary hypertension (PH), the presence of comorbidities can lead to difficulties in distinguishing between Group 1 PH (PAH) and the other group classifications of PH. Many comorbidities contribute to the progression of PAH through increased pulmonary artery pressures and cardiac output, therefore treatment of the comorbidity may also reduce the severity of PAH. Similarly, the development of one comorbidity can be a risk factor for the development of other comorbidities. The management of comorbidities requires consideration of drug interactions, polypharmacy, adherence and evidence-based strategies. A multidisciplinary team should be involved in the management of patients with PAH and comorbidities, with appropriate referral to supportive services when necessary. The treatment goals and expectations of patients must be managed in the context of comorbidities.

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“…It has been well documented that depression and diminished mental functioning are part of the PAH picture [40,49]. In addition, diseasespecific symptoms such as shortness of breath can adversely affect health related QoL (HRQoL), increase anxiety and be independently related to depression [50][51][52].…”

Section: Psychosomatic Considerationsmentioning

confidence: 99%

Pulmonary arterial hypertension in the elderly: Clinical perspectives

et al. 2020

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Pulmonary hypertension (PH) is a rare and devastating disease characterized by progressive increases in pulmonary arterial pressure and pulmonary vascular resistance, which eventually leads to right ventricular failure and death. Pulmonary arterial hypertension (PAH) (World Health Organization Group I), a subset of PH, and may be idiopathic in nature or associated with other systemic conditions and is thought to most commonly effect women, the majority of whom are of childbearing age. However, PAH in the elderly population is being increasingly diagnosed creating clinical considerations that had once not been considered. Often in an elderly population the diagnosis of PAH may be delayed due to chronic comorbid conditions such as coronary artery disease or other dyspneic conditions. Though survival and clinical outcomes have improved, the elderly population continues to have disproportionately lower survival rates. High clinical suspicion of PAH warrants a complete diagnostic workup with right heart catheterization. Upon diagnosis, PAH specific therapy should be initiated with possible drug interactions in mind. Adjuvant pulmonary rehabilitation should be considered as a conservative measure with definitive results. Finally, psychosomatic aspects of the disease should also be considered in elderly populations.

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Depression in pulmonary arterial hypertension: An undertreated comorbidity

Cited by 16 publications

References 37 publications

‘Tired, afraid, breathless … .’ An international survey of the exercise experience for people living with pulmonary hypertension

‘Tired, afraid, breathless … .’ An international survey of the exercise experience for people living with pulmonary hypertension

The burden of comorbidities in pulmonary arterial hypertension

Pulmonary arterial hypertension in the elderly: Clinical perspectives

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