Depression and Anxiety in Heart Failure

Quality of life and life expectancy are severely impaired in heart failure. Besides somatic disease features, depression and anxiety may impact adversely on clinical outcomes. Compared with the general population, negative mood states are much more common in heart failure. Thus, depression, often associated with anxiety, is up to 5-times more common, with significant adverse effects on morbidity, mortality, quality of life and treatment costs. Bidirectional biological interrelations between these somatic and psychological disorders, demographic, psychosocial and behavioral factors and perceived losses (e.g. health, income) modulate the individual clinical picture and the course of the disease. Depressive symptoms and anxiety overlap with those of heart failure which renders diagnosis difficult. Simple screening tools, e.g. the two-item patient health questionnaire or the two-item questionnaire on generalized anxiety and depression ease recognition of depression and anxiety. To date, there is no evidence that antidepressant or anxiolytic pharmacotherapy improves mood and clinical outcomes in patients with heart failure and comorbid depression and / or anxiety, and antidepressant pharmacotherapy or anxiolytic therapy remains to be decided on a by-case basis. However, physical training, cognitive behavioral therapy and multidisciplinary comprehensive disease management improved symptoms and/or prognosis in a limited number of randomized studies.