Treating Anxiety, Depression in Heart Disease Patients Reduces Hospitalization

Philip Binkley, MD, MPH

Credit: The Ohio State University, Wexner Medical Center

Treating anxiety and depression can do more than improve someone’s well-being—it can save a life, at least in the cases of people with heart disease.¹ A new study found people with heart disease who are treated for anxiety and depression have significantly reduced emergency room visits and hospital readmissions.

“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 lead investigator Philip Binkley, MD, MPH, executive vice chair of the department of internal medicine and emeritus professor of internal medicine and public health at The Ohio State University, in a press release.² “In some cases, there was a reduction in death.”

People with heart failure often experience anxiety and depression.¹ Mental health can increase an individual’s risk of other health conditions, disability, and death.

Investigators conducted a population-based, retrospective, cohort design to assess the link between mental health treatment with antidepressant medication or psychotherapy—or a combination of the two—and emergency room visits, hospital readmissions, all-cause mortality, and heart disease mortality in people with coronary artery disease or heart failure. Participants had an official diagnosis of anxiety or depression before hospitalization.

“Heart disease and anxiety/depression interact such that each promotes the other,” Binkley said.² “There appear 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.”

The study included 1563 adults aged 22 – 64 (mean age: 50.1 years) who enrolled over a 3-year period^.1 Participants had a hospital admission for blocked arteries or heart failure and had ≥ 2 health insurance claims for anxiety or depression. In total, 68% of participants were women and 80.9% were reported as White.

All participants were enrolled in Ohio’s Medicaid program during the 6 months before the hospital admission. The team leveraged data from Ohio Medicaid claims and Ohio death certificate files from July 1, 2009, to June 30, 2012. They followed participants through either the end of 2014, death, or the end of Medicaid enrollment.

Before hospitalization, approximately 92% of participants were diagnosed with anxiety and 55.5% were diagnosed with depression. Approximately 23% of participants received both antidepressant medications and psychotherapy, nearly 15% received only psychotherapy, 29% only took antidepressants, and 33% received no mental health treatment.

A combination of antidepressants and psychotherapy for anxiety or depression reduced the risk of hospitalization (from 68% to 75%), an emergency department visit (67% to 74%), and death (67%). The 3 models showed all treatments were linked to significant reductions in the risk for emergency department visits (P < .001). As for hospital readmissions, the risk was significantly reduced for all treatments in the 3 models (P < .001).

Only having psychotherapy reduced the risk of hospital readmission (46 – 49%) and emergency room visits (48% - 53%). Only taking medication hospital reduced readmission by 58% and reduced emergency room visits by 49%.

Investigators pointed out the study was limited to people enrolled in Medicaid so the findings may not be representative of people with other insurance plans. Additionally, most of the sample was White, so the results may not apply to other races or ethnicities.

“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,” Binkley said.² “I would also hope these findings inspire additional research regarding the mechanistic connections between mental health and heart disease.”

^References

1. ^{Carmin CN, Ownby RL, Fontanella C, Steelesmith D, Binkley PF. Impact of Mental Health Treatment on Outcomes in Patients With Heart Failure and Ischemic Heart Disease. J Am Heart Assoc. Published online March 20, 2024. doi:10.1161/JAHA.123.031117}
2. ^{Treating Anxiety, Depression in People with Heart Disease Reduced ER Visits, Hospitalizations. EurekAlert! March 20, 2024. https://www.eurekalert.org/news-releases/1038357. Accessed March 22, 2024.}