Anxiety and Depression in Chronic Heart Failure. What Can a Cardiologist Do?

Aim. To reveal the probability and duration of the onset of remission of anxiety-depressive symptoms in patients with CHF III-IV receiving optimal medicine treatment (OMT ) or (OMT ), supplemented with the education program and active outpatient monitoring (OMT + A). Materials and methods. A secondary analysis of the results of RCT CHANCE, which studied the impact of the training program and active outpatient control (further additional exposure (DV) plus optimal medication (OMT) on mortality and cardiovascular hospitalization in patients with CHF III-IV FC. Therapeutic training and outpatient control performed by the cardiologist after discharge from the hospital (weekly in the first month, every 2 weeks for the next 2 months, and then On the basis of the results of the telephone contact, an additional visit could be scheduled, the CHANCE study control group was made up of patients on OMT who were observed as practiced in regular health care setting. Control group had 4 visits to the cardiologist during the 1 year observation. The present analysis included patients on OMT and OMT + DV who had a clinically significant anxiety at the 0 week of the CHANCE program using the Hospital Anxiety and Depression Scale (HADS) (the sum of scores on the anxiety subscale >11), depression (the sum of scores on the depression subscale >11), or a combination of anxiety and depressive symptoms (scores on anxiety and depression subscales >11). Patients who did not pass HADS or SHOCK testing at 0.24 and 48 weeks were excluded from the analyses. A total of 237 patients were included. Severity of HF symptoms were assessed by “Scale of Heart failure Optimizing Clinical Status (SHOCS)” and compared it with the shares of patients who reached remission (HADS scores <11). Results. The sum of SHOCS scores between 0 and 24 weeks in patients in OMT group decreased by 1.9±3.9 in OMT + DV group by -3.8±3.9 (p=0.00007). These differences persisted even at the end of the CHANCE program (p=0.0002), although between 24 and 48 weeks the rate of decrease in the sum of scores in both subgroups slowed to ≈ 1, 2 points (p=0.90). Against the backdrop of pronounced positive dynamics of clinical manifestations of CHF more than 50% of patients, both in the group of OMT, and the group of OMT + DV achieved a remission of anxious and depressive disorders. The symptomatology of mixed anxiety-depressive disorders significantly decreased only in the OMT + DV group. During the period from 24 to 48 weeks, OMT + DV showed comparable efficacy to HTA in the effect on combined anxiety and depressive symptoms. At the same time, OMT + DV was associated with an increased remission rate in patients with depressive (p = 0.05), but not anxious (p=0.72) symptoms. In addition, OMT + DV often contributed to the preservation of remission, which was achieved by week 24 (p=0.01). As a result, by the end of the CHANCE program, the remission level of all studied somato-psychiatric disorders (anxiety, depression, anxiety and depression) with OMT + DV was significantly higher than with OMT alone (p=0.04). Conclusion. The use of education and active outpatient control in addition to optimal medical therapy allows to reach the remission of anxiety-depressive symptoms after 24th week of treatment and prolong it further, at least for the next 6 months in 89.6% of patients with CHF III-IV FC.

сердечная недостаточность, терапевтическое обучение, амбулаторный контроль, депрессия, тревожность, ШОКС, heart failure, patient education, outpatient control, depression, anxiety, remission, SHOKS

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