Patients hospitalized for coronary artery disease or HF who received some form of mental health treatment for comorbid anxiety or depression had lower rates of all-cause mortality, ED visits, and hospital readmissions than nontreated patients.

This summary is based on the publication of Carmin CN, Ownby RL, Fontanella C, et al. - Impact of Mental Health Treatment on Outcomes in Patients With Heart Failure and Ischemic Heart Disease. J Am Heart Assoc. 2024 Apr 2;13(7):e031117. doi: 10.1161/JAHA.123.031117

Introduction and methods

Background

In patients with HF or coronary artery disease (CAD), comorbid depression and anxiety have a major impact on their morbidity and mortality [1-8]. In addition, depression and anxiety are predictors of ambulatory healthcare use and rehospitalization in patients with cardiac disease [9,10]. However, evidence for the impact of mental health treatment on outcomes in HF and CAD is conflicting.

Aim of the study

The authors investigated the impact of psychotherapy and/or psychopharmacological treatment on adverse outcomes in patients who were admitted to the hospital for CAD or HF and were also diagnosed with anxiety or depression.

Methods

In a population-based retrospective cohort study, 1563 patients aged 21–64 years with a first hospital admission for CAD or HF and comorbid depression or anxiety disorder who were enrolled in the Ohio Medicaid program (which provides healthcare coverage to low-income state residents) in the US were included from July 2009 through June 2012. Data on patient demographic and clinical characteristics and outpatient, inpatient, and pharmacy service claims were extracted from the Ohio Medicaid claims files.

Outcomes

The outcomes were all‐cause mortality, CAD-related mortality, emergency department (ED) visits for CAD or HF, and hospital readmission.

Main results

All-cause mortality

• In the most extensive model (i.e., model 3, which was corrected for demographic characteristics, disability status, interaction of age with disability, comorbid disorders, all medication use, and prior mental health treatment), patients who received both psychotherapy and antidepressant medication (n=363) had a lower risk of all-cause mortality than those receiving no mental health treatment (n=515) (HR: 0.34; 95%CI: 0.21–0.55; P<0.001), as did patients receiving psychotherapy only (n=231) (HR: 0.52; 95%CI: 0.37–0.75; P<0.001).
• However, patients receiving antidepressants only (n=454) did not show a significantly lower mortality risk compared with nontreated patients (HR: 0.70; 95%CI: 0.47–1.04; P=0.09).

Cardiac disease mortality

• Mental health treatment was not associated with a reduced risk of CAD-related mortality in any of the 3 models (all P>0.05).

Emergency department visits

• Patients receiving psychotherapy and antidepressants were less likely to visit the ED than patients who did not receive mental health treatment in the most extensive model (HR: 0.26; 95%CI: 0.20–0.34; P<0.001).
• The same applied to patients receiving psychotherapy only (HR: 0.47; 95%CI: 0.37–0.59; P<0.001) and those on antidepressants alone (HR: 0.51; 95%CI: 0.42–0.62; P<0.001).

Hospital readmission

• Compared with patients who did not receive mental health treatment, the frequency of rehospitalization in the most extensive model was also lower in patients receiving psychotherapy and antidepressants (HR: 0.25; 95%CI: 0.19–0.34; P<0.001), those receiving psychotherapy only (HR: 0.51; 95%CI: 0.41–0.64; P<0.001), and those receiving antidepressants only (HR: 0.42; 95%CI: 0.34–0.52; P<0.001).

Conclusion

In this population-based retrospective cohort study, patients hospitalized for CAD or HF who received psychotherapy, antidepressant medication, or a combination of both for comorbid anxiety or depression showed lower rates of ED visits (up to –74%) and hospital readmissions (up to –75%) compared with patients who did not receive mental health treatment. Those receiving both psychotherapy and antidepressants or psychotherapy only also had a lower risk of all-cause mortality (up to –66%). The risk of CAD-related mortality, however, was not reduced.

The authors believe that all patients with cardiac disease should be screened for anxiety and depression. “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.”

Find this article online at J Am Heart Assoc.

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