Heart disease: Treating anxiety, depression may reduce ER visits – Medical News Today

Anxiety and depression are two prevalent mental health conditions. Proper treatment of these conditions is essential to well-being, and research is ongoing about how treatment benefits other health areas, including heart health.
A study recently published in the Journal of the American Heart Association examined how treatment of anxiety and depression impacted heart health outcomes among people who had already experienced severe heart problems.
Including over 1,500 participants, the study found that individuals who received medication and psychotherapy for anxiety or depression were 75% less likely to have to stay in the hospital again, and 74% less likely to have to visit the emergency room.
The results highlight the importance of treating mental health conditions to improve outcomes for people who already have heart problems.
Depression is a common mental health condition. People with depression can experience persistent feelings of hopelessness and energy declines. They may have difficulty with going about their everyday lives.
Anxiety is another common mental health condition. People with anxiety can experience difficulty sleeping, persistent feelings of worry, and feelings of restlessness. People with anxiety can also be at an increased risk for depression.
Poor mental well-being can negatively influence physical health. For example, people with depression who also have a chronic illness such as diabetes or heart disease may have worse symptoms from both conditions. People with anxiety can also be at a higher risk for cardiovascular disease.
Cheng-Han Chen, MD, a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who was not involved in the study, explained to Medical News Today:
“There is a very close relationship between mental health and cardiovascular disease, a relationship that has impact in both directions. People with disorders such as depression and anxiety can experience increased blood pressure and physiological stress that are risk factors for heart disease.”
“In addition,” he noted, “they may be more prone to adopt lifestyle changes, such as smoking and physical inactivity, that can further increase their risk of developing cardiovascular disease. Inversely, patients who suffer from heart disease such as heart attack, stroke, or heart failure, are at greater risk to develop mental health disorders such as anxiety, depression, or PTSD [post-traumatic stress disorder], after their stressful acute cardiovascular event.”
The exact relationship between mental ill health and physical conditions is not something that researchers understand entirely.
Researchers of the current study wanted to understand more about the relationship between certain heart problems, and anxiety and depression.
This study was a population-based, retrospective cohort study. Researchers included 1,563 participants using Ohio Medicaid data in their analysis.
Participants had coronary artery disease or heart failure and they also had anxiety or depression. They had also experienced their first hospital admission related to heart failure or ischemic heart diseases.
Researchers looked at treatment for anxiety and depression and how this related to hospital readmission, emergency room visits for heart failure and coronary artery disease, all-cause mortality, and heart disease mortality. They looked at if participants received psychotherapy and if they were taking antidepressant medication.
They noted and accounted for several covariates, including ethnicity, Medicaid eligibility, and biological sex. They ran various models that adjusted for different covariates.
The analysis found that people who received both psychotherapy and medication for depression or anxiety experienced the most benefits and the most risk reductions.
However, all groups that received some form of treatment saw benefits regarding rehospitalization and emergency room visits. Researchers did not observe significant reductions in risk for heart disease mortality for those treated for anxiety and depression.
Those who received both medication and psychotherapy were 75% less likely to be admitted to the hospital again, 74% less likely to have to go to the emergency room, and 66% less likely to experience death from any cause.
The results point to the importance of treating mental illness in people who have heart disease as a way to help improve heart disease outcomes.
Study author Philip F. Binkley, MD, professor of internal medicine and director of cardiovascular research for the Division of Cardiovascular Medicine at Ohio State’s Wexner Medical Center, explained the key findings of the study to MNT.
He told us that “[p]atients who have been admitted to the hospital with heart failure or coronary artery disease who have anxiety or depression benefit from mental health treatment consisting of psychotherapy, pharmacotherapy, or the combination of both.”
“Those who receive the combination of psychotherapy and pharmacotherapy have the greatest benefit,” he noted. “In all cases, there are significant reductions in the need to return to the hospital or go to the emergency room, and the risk of death is decreased.”
Majid Basit, MD, an interventional cardiologist with Memorial Hermann in Houston, who was not involved in the study, also commented with his thoughts on the study:
“The study shows the importance of recognizing mental health disorders like anxiety and depression in patients with cardiovascular disease. It is especially important in vulnerable populations, such as the elderly, those with advanced heart disease, and those with previous hospitalizations for cardiovascular disease.”
This research has a number of limitations. First, it only included participants to Ohio Medicaid and gathered data from their submitted claims, so some data may be missing. The research also cannot identify a causal relationship between the factors that the researchers examined.
A large majority of participants were white, so future research could focus on studying other groups. Researchers also did not include adults over the age of 64, so future research should also include older participants.
The study also only lasted for a relatively short timeframe, so more extended studies can also work to confirm these findings.
Researchers may have missed certain confounders and were unable to account for certain factors, such as the severity of illness. They also were not able to confirm the mental health diagnoses using standardized assessments.
Binkley emphasized:
“This was a retrospective study and further prospective studies of mental health interventions in patients with heart disease are required. Mechanistic studies further elucidating the physiologic connections between heart disease and mental health challenges will further advance our capacity to prevent and treat both disorders.”
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