Woman with depression with head in hands
Credit: Tom Merton/Getty Images

Ohio State University researchers have published a study that shows treating people with heart disease who have symptoms of depression and anxiety significantly decreased visits to the emergency room and rehospitalizations. The research, published today in the Journal of the American Heart Association, noted that depression and anxiety are common in people with heart failure.

“For patients who had been hospitalized for coronary artery disease or heart failure and who had diagnoses of anxiety or depression, treatment with psychotherapy, pharmacotherapy or a combination of the two was associated with as much as a 75% reduction in hospitalizations or emergency room visits,” said Philip Binkley, MD, executive vice chair of the department of internal medicine and emeritus professor of internal medicine and public health at The Ohio State University. “In some cases, there was a reduction in death.”

For this research, the investigators enrolled, over three years, 1,563 patients between the ages of 22 and 64 who had a first admission to the hospital for blocked arteries or heart failure and who also had two or more insurance claims for depression or an anxiety disorder. Sixty-eight percent of study subjects were women and 81% were white. All of the participants were enrolled in the state of Ohio’s Medicaid program during the six months prior to their hospitalization.

Health data for the research was drawn from two sources: Medicaid claims and Ohio death certificates from July 1, 2009 to June 30, 2012. All study participants were followed until the end of 2014 or the end of their enrollment in Medicaid.

Treatment for their anxiety and depression varied among the cohort:

  • 23% of participants received both antidepressant medications and psychotherapy;
  • 15% received psychotherapy alone;
  • 29% took antidepressants alone; and
  • 33% received no mental health treatment.

The study found notable reductions in ER visits and rehospitalizations for those receiving some kind of treatment for anxiety and depression with the largest reductions in the group of patients who received both medication and talk therapy to treat their conditions. Among this group, the risk of rehospitalization was reduced between 68% to 75% and the risk of a visit to the ER was similarly reduced between 67% to 74%. Any cause risk of death was reduced by 65% to 67%.

Other treatment methods showed benefits, though not as marked: Psychotherapy treatment alone was associated with a 46% to 49% reduction of risk for hospital readmission and a 48% to 53% reduction in emergency room visits, while medication treatment alone reduced hospital readmission by 47% to 58% and reduced ER visits by 41% to 49%.

“Heart disease and anxiety/depression interact such that each promotes the other,” noted Binkley who is the lead author of the study. “There appears to be psychological mechanisms that link heart disease with anxiety and depression that are currently under investigation. Both heart disease and anxiety/depression are associated with activation of the sympathetic nervous system. This is part of the so-called involuntary nervous system that increases heart rate, blood pressure and can also contribute to anxiety and depression.”

Binkley noted that the research points to the benefit of combining treatment of anxiety and depression among patients with cardiovascular disease.

“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,” he concluded. “I would also hope these findings inspire additional research regarding the mechanistic connections between mental health and heart disease.”

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