Pathophysiological Relationships Between Heart Failure and Depression and Anxiety

Abstract

H eart failure is an epidemic with national and global implications. Compared with the situation in other cardiac diseases, the incidence and prevalence of heart failure continue to increase despite recent advancements in understanding and treatment. Increased survival after myocardial infarction, aging of the population, and increased incidence of diabetes are contributing factors. This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Describe the biopsychosocial holistic model for cardiovascular health 2. Identify 2 neurohormonal pathways and their impact in heart failure 3. Identify nursing implications for heart failure, depression, and anxiety CNE Continuing Nursing EducationCover Depression and anxiety are common comorbid conditions in patients with heart failure. Patients with heart failure and depression have increased mortality. The association of anxiety with increased mortality in patients with heart failure is not established. The purpose of this article is to illustrate the similarities of the underlying pathophysiology of heart failure, depression, and anxiety by using the Biopsychosocial Holistic Model of Cardiovascular Health. Depression and anxiety affect biological processes of cardiovascular function in patients with heart failure by altering neurohormonal function via activation of the hypothalamic-pituitary-adrenal axis, autonomic dysregulation, and activation of cytokine cascades and platelets. Patients with heart failure and depression or anxiety may exhibit a continued cycle of heart failure progression, increased depression, and increased anxiety. Understanding the underlying pathophysiological relationships in patients with heart failure who experience comorbid depression and/or anxiety is critical in order to implement appropriate treatments, educate patients and caregivers, and educate other health professionals. (Critical Care Nurse. 2014;34[2]:14-25)

Psychotropic medication use trends in a large pediatric and young adult solid organ transplant population

“…Indeed, abdominal organ transplant patient rates of psychiatric disorders are high compared to general youth populations, and there may be other factors (eg, poor gastric absorption, hepatic metabolism or renal clearance limiting psychotropic prescription) in abdominal transplant candidates that result in less incidence of lifetime psychotropic medications. The higher incidence of psychotropic medication use in thoracic organ patients may be attributable to multiple factors previously discussed in different literatures: earlier involvement of transplant psychology/psychiatry in these patients due to psychiatric diagnosis screening mandates and psychiatric awareness in this patient population (eg, CF consortium standards), prolonged time in the ICU pre‐ and post‐transplant with subsequent higher risk for psychiatric distress and delirium (eg, on bypass/ECMO), and physiologic anxiety due to worsening heart and lung physiology . As standardized delirium assessment was not conducted for these patients, the association with delirium, unfortunately, could not be further evaluated in detail.…”

“…The higher incidence of psychotropic medication use in thoracic organ patients may be attributable to multiple factors previously discussed in different literatures: earlier involvement of transplant psychology/psychiatry in these patients due to psychiatric diagnosis screening mandates and psychiatric awareness in this patient population (eg, CF consortium standards), 5,6 prolonged time in the ICU pre-and post-transplant with subsequent higher risk for psychiatric distress and delirium (eg, on bypass/ECMO), 16,17 and physiologic anxiety due to worsening heart and lung physiology. 18 As standardized delirium assessment was not conducted for these patients, the association with delirium, unfortunately, could not be further evaluated in detail. We suspect delirium would have had a significant association and high odds of psychotropic usage in thoracic organ population given the prolonged periods of time in the ICU and frequency of events that impact acute neurocognitive functioning (eg, hypotension, sepsis, hypercapnia, hypoxemia, and mechanical ventilation).…”

Post-translational regulation of neuronal nitric oxide synthase: implications for sympathoexcitatory states

“…This reduces the NO-mediated inhibitory influence and thus an over-activation of the sympathoexcitatory drive from the PVN in CHF. There is high co-morbidity in patients with depression, anxiety, heart failure, and other heart disease [121, 122]. However, the cause(s) for this significant correlation and coincidence of occurrence and underlying pathophysiological relation are not yet known.…”

A Study to Assess the Prevalence of Depression in Cardiovascular Disease Patient in The Nilgiris Population: Association with Blood Pressure

“…Patients with depressive disorder carry a double risk of developing heart disease (Raic, 2017). Increased CV risk of depressive patients indicates an increased incidence of MI and CHD, and consequently higher mortality rate (Correll et al, 2017;Chapa et al, 2014;To ler et al, 2017). Depression becomes an independent risk factor for the development of coronary artery disease, in both sexes, if other risk factors are under control (Raic, 2017).…”