Psychological support shown to prevent readmission in cardiac patients.
Psychological support protects heart disease patients from hospital readmission and presentation at emergency departments, research suggests.
A senior Australian clinician says accessing that support is a major challenge, however, particularly for First Nations people living in remote parts of the country.
Cardiologist and the Heart Foundation’s chief medical advisor Professor Garry Jennings said mental health support was “a fairly routine element of cardiac rehabilitation”, but the uptake of cardiac rehabilitation people in people who have had cardiac events in Australia was low.
“Everybody is rocked mentally by a cardiac event and being in hospital, and everybody needs some kind of support,” he told TMR.
“Many of the people that need it won’t sing out after their event. They’ve had plenty of physical care for their condition but may not even recognise themselves the extent to which they’ve been affected mentally.”
The US study, including more than 1500 adults with coronary artery disease or heart failure and anxiety or depression, found those who received both psychotherapy and antidepressant medication were 75% less likely to be readmitted to hospital over the three-year duration of the study.
They were also 74% less likely to visit an emergency department and 66% less likely to die from any cause.
Psychotherapy treatment alone was associated with a 49% reduction of risk for hospital readmission and a 53% reduction in emergency room visits. Medication treatment alone reduced hospital readmission by 58% and ER visits by 49%.
“These findings indicate that mental health interventions are essential to reducing hospitalisations and ED visits in patients with heart failure or coronary disease and concomitant depression or anxiety,” the researchers said in the Journal of the American Heart Association.
Patients with heart disease should also be screened for anxiety and depression, the researchers said.
“Patients with a definitive diagnosis of anxiety or depression should undergo appropriate treatment to improve cardiovascular outcomes as well as to treat the primary mental health diagnosis, and collaborative care between cardiovascular experts and mental health professionals should be established to advance the care of those with heart disease.”
About 92% of participants in the study were diagnosed with anxiety and 55% with depression before they were hospitalised.
Professor Jennings said the study participants who had psychological support may have been in a higher socio-economic group or had better access to psychological or clinical support.
“There are many people that probably would benefit from psychological support after an event who don’t get it, and that particularly applies to First Nations people in remote communities,” he told TMR.
“It’s not that easy to get mental health support in Australia unless you’re very fortunate.”
GPs played a key role in checking on patients’ mental health after a cardiovascular event, he said.
“Be ready to seek support from psychologists and other allied health people that might be able to assist,” he said.
Professor Jennings said there was a range of reasons why cardiac patients may do better with mental health support.
“Being in a better frame of mind, you’re more likely to take your medications, you’re more likely to turn up for appointments, you’re more likely to follow your nutrition and physical activity guidelines,” he said.
“It might even help you get off tobacco smoking.”
Professor Jennings noted that the study could not show cause and effect as it was a retrospective cohort study.
According to the study authors, heart disease, depression, and anxiety substantially impaired quality of life and were “mechanistically linked such that each contributes to the progression of the other further contributing to diminished quality of life”.
“Indeed, coexistence of depression results in perception of symptom severity that exceeds measures of actual functional impairment,” they wrote.
Lead author, Philip Binkley, executive vice chair of the department of internal medicine and emeritus professor of internal medicine and public health at The Ohio State University, told media there appeared to be psychologic mechanisms that linked heart disease with anxiety and depression, and these were currently under investigation.
“Both heart disease and anxiety/depression are associated with activation of the sympathetic nervous system,” he said.
“This is part of the so-called involuntary nervous system that increases heart rate, blood pressure and can also contribute to anxiety and depression.
“I hope the results of our study motivate cardiologists and health care professionals to screen routinely for depression and anxiety and demonstrate that collaborative care models are essential for the management of cardiovascular and mental health.”
Journal of the American Heart Association 2024, online 20 March
