Psychosoziale Faktoren bei Herzinsuffizienz: Mehr als eine Komorbidität?

Abstract

Several psychosocial factors increase the incidence of congestive heart failure (CHF) and worsen the course of the disease. However, in clinical practice psychosocial factors are generally less taken into account than somatic factors. The former include depression, anxiety disorders, and cognitive changes, whose prevalence may be as high as 60 percent in CHF, as well as socioeconomic status and poor social support. These psychosocial factors not only reduce the health-related quality of life and have a negative impact on adherence, but also increase morbidity and mortality in CHF. The diagnosis can be made using simple instruments (e. g. targeted questions and/or validated questionnaires).

Besides psychotherapeutic treatment modalities psychotropic drugs may be required. However, the potential side-effects of the latter have to be considered (e. g. induction of life threatening arrhythmias). Several antidepressants, such as lithium and tricyclic antidepressants, are contraindicated in CHF. SSRI are thought to be safe and to relief symptoms, however, their prognostic benefit has yet to be demonstrated in CHF. A holistic approach with intensified individualized medical support including psychosomatic basic care appears to be of utmost importance which may require further support by psychotherapists, psychatrists, specifically qualified nurses and sport and movement therapists.

• Literatur

• 1 Ladwig KH, Lederbogen F, Albus C et al. Positionspapier zur Bedeutung psychosozialer Faktoren in der Kardiologie – Update 2013. Kardiologe 2013; 7: 7-27
• 2 McMurray JJV, Adamopoulos S, Anker SD et al. ESC Guidelines fort the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J 2012; 33: 1787-1847
• 3 Jünger J, Schellberg D, Kraemer S et al. Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart 2002; 87: 235-241
• 4 Rutledge R, Reis VA, Linke SE et al. Depression in heart failure – a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol 2006; 48: 1527-1537
• 5 Haass M, Müller-Tasch T, Jünger J. Depression bei chronischer Herzinsuffizienz. Kardiol up2date 2007; 3: 7-12
• 6 Lossnitzer N, Herzog W, Störk S et al. Incidence rates and predictors of major and minor depression in patients with heart failure. Int J Cardiol 2013; 167: 502-507
• 7 Johansson P, Lesman-Leegte I, Lundgren J et al. Time-course of depressive symptoms in patients with heart failure. J Psychosom Res 2013; 74: 238-243
• 8 Jünger J, Schellberg D, Müller-Tasch T et al. Depression increasingly predicts mortality in the course of congestive heart failure. Eur J Heart Fail 2005; 7: 261-267
• 9 Moraska AR, Chamberlain AM, Shan ND et al. Depression, healthcare utilization, and death in heart failure: a community study. Circ Heart Fail 2013; 6: 387-394
• 10 Wu JR, Lennie TA, Dekker RL et al. Medication adherence, depressive symptoms, an cardiac event-free survival in patients with heart failure. J Card Fail 2013; 19: 317-324
• 11 Versteeg H, Hoogwegt MT, Hansen TB et al. Depression, not anxiety, is independently associated with 5-year hospitalizations and mortality in patients with ischemic heart disease. J Psychosom Res 2013; 75: 518-525
• 12 Volz A, Schmid JP, Zwahlen M et al. Predictors of readmission and health related quality of life in patients with chronic heart failure: a comparison of different psychosocial apsects. J behav Med 2011; 34: 13-22
• 13 Yohannes AW, Wilgoss TG, Baldwin RC et al. Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles. Int J Geriatr Psychiatry 2010; 25: 1209-1221
• 14 Geiser F, Kleiman A, Albus C et al. Angststörungen. Internist 2012; 53: 1289-1290
• 15 O’Donnel M, Teo K, Gao P et al. Cognitive impairment and risk of cardiovascular events and mortality. Eur Heart J 2012; 33: 1777-1786
• 16 Vogels RL, Scheltens P, Schroeder-Tanka JM et al. Cognitive impairment in heart failure: a systematic review of the literature. Eur J Heart Fail 2007; 9: 440-449
• 17 Steinberg G, Lossnitzer N, Schellberg D et al. Peak oxygen uptake and left ventricular ejection, but not depressive symptoms, are associated with cognitive impairment in patients with chronic heart failure. Int J Gen Med 2011; 4: 879-887
• 18 Almeida OP, Garrido GJ, Beer C et al. Cognitive and brain changes associated with ischaemic heart disease and heart failure. Eur Heart J 2012; 33: 1769-1776
• 19 Kindermann I, Fischer D, Karbach J et al. Cognitive function in patients with decompensated heart failure. The Cognitive Impairment in heart failure (CogImpair-HF) study. Eur J Heart Fail 2012; 14: 404-413
• 20 Chung ML, Lennie TA, Dekker RL et al. Depressive symptoms and poor social support have a synergistic effect on event-free survival in patients with heart failure. Heart Lung 2011; 40: 492-501
• 21 Heo S, Moser DK, Chung ML et al. Social status, health-related quality of life, and event-free survival in patients with heart failure. Eur J Cardiovasc Nurs 2012; 11: 141-149
• 22 Spaderna H, Mendell NR, Zahn D et al. Social isolation and depression predict 12-month outcomes in the „waiting for a new heart study“. J Heart Lung Transplant 2010; 29: 247-254
• 23 O’Connor CM, Jiang W, Kuchibhatla M et al. Safety and efficiacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial. J Am Coll Cardiol 2010; 56: 692-699
• 24 Angermann CE, Gelbrich G, Störk S et al. Rationale and design of a randomised, controlled, multicenter trial investigating the effects of selective serotonin re-uptake inhibition on morbidity, mortality and mood in depressed heart failure patients (MOOD-HF). Eur J Heart Fail 2007; 9: 1212-1222
• 25 Blumenthal JA, Babyak M, O´Connor C et al. Effects of exercise training on depressive symptoms in patients with chronic heart failure: the HF-ACTION randomized trial. JAMA 2012; 308: 465-474
• 26 Angermann CE, Störk S, Gelbrich G et al. Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure: the Interdisciplinary Network for Heart Failure (INH) study. Circ Heart Fail 2012; 5: 25-35