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Neuropsychiatric disorders in patients with heart failure: not to be ignored

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Abstract

Among various neuropsychiatric disorders, depression and anxiety are commonly encountered in patients with heart failure (HF), reported in ≥ 50% of patients attending a HF clinic, but may frequently elude clinician’s attention. Both disorders are associated with the development and progression of HF, incurring higher rates of morbidity/mortality, probably via physiologic and behavioral mechanisms. Patients with devices and/or advanced HF are more severely affected, especially early following device receipt. In addition, various other neuropsychiatric and neuropsychological disorders and symptoms of these and other disorders occur in and impact HF patients, including sleep disorders and cognitive impairment, which further interact with and amplify depression and anxiety. Mechanisms involved in the link between neuropsychiatric/neuropsychological disorders and HF may relate to pathophysiological processes, lifestyle factors, and behavioral patterns. Among the pathophysiological factors, inflammation, autonomic dysfunction, endothelial dysfunction, thrombotic mechanisms, and dysregulation of the hypothalamic–pituitary–adrenal axis may play a significant role as they are implicated in the pathogenesis, progression, and prognosis of HF. Multimodal psychiatric management strategies with flexible approaches, using antidepressants/anxiolytics/atypical antipsychotics and various psychotherapies such as cognitive behavioral therapy combined with exercise adjusted to patients’ care and needs, appear promising in this patient group. Choosing agents with a higher efficacy/safety profile is a prudent strategy. Although depression and anxiety are risk factors for mortality in HF patients, indiscriminate use of psychiatric medications may not improve or even worsen survival when one neglects to closely monitor for potential proarrhythmic and other side effects. Newer meta-analytic data in HF patients indicate no increase in mortality for newer antidepressants, while secondary analyses show improved survival in patients who achieved remission of depressive symptoms.

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Abbreviations

ACE:

angiotensin converting enzyme

ANS:

autonomic nervous system

ARB:

angiotensin receptor blocker

CAD:

coronary artery disease

CBT:

cognitive behavioral therapy

CRP:

C-reactive protein

CRT:

cardiac resynchronization therapy

CV:

cardiovascular

CVD:

cardiovascular disease

HF:

heart failure

HFpEF:

heart failure with preserved ejection fraction

HFrEF:

heart failure with reduced ejection fraction

HRV:

heart rate variability

ICD:

implantable cardioverter defibrillator

IL:

interleukin

LV:

eft ventric-le(- ular)

LVEF:

left ventricular ejection fraction

MI:

myocardial infarction

NYHA:

New York Heart Association

TNF:

tumor necrosis factor

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Authors and Affiliations

  1. Aiginiteio University Hospital, Athens, Greece

    Theodora A. Manolis

  2. Patras University School of Medicine, Patras, Greece

    Antonis A. Manolis

  3. Onassis Cardiac Surgery Center, Athens, Greece

    Helen Melita

  4. First Department of Cardiology, Athens University School of Medicine, Ippokrateio Hospital, Vas. Sofias 114, 115 27, Athens, Greece

    Antonis S. Manolis

Authors
  1. Theodora A. Manolis
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  2. Antonis A. Manolis
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  3. Helen Melita
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All authors contributed to the preparation of this manuscript and approved the final version. TAM conceived and designed the project, conducted literature search, wrote the initial draft, designed the figures, and revised the manuscript; AAM conducted literature search, constructed the tables, and edited/revised the manuscript; HM analyzed the data, edited/revised, and approved the manuscript; ASM supervised the project, curated/analyzed the data, and edited/approved the final product.

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Correspondence to Antonis S. Manolis.

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Manolis, T.A., Manolis, A.A., Melita, H. et al. Neuropsychiatric disorders in patients with heart failure: not to be ignored. Heart Fail Rev 28, 821–858 (2023). https://doi.org/10.1007/s10741-022-10290-2

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